Provider Demographics
NPI:1205924479
Name:FOX, RICHARD MAURICE (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MAURICE
Last Name:FOX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2508
Mailing Address - Country:US
Mailing Address - Phone:318-797-0006
Mailing Address - Fax:318-797-2890
Practice Address - Street 1:406 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2508
Practice Address - Country:US
Practice Address - Phone:318-797-0006
Practice Address - Fax:318-797-2890
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice