Provider Demographics
NPI:1245862499
Name:FOX, GAVIN CONNOR (DDS, MDS)
Entity type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:CONNOR
Last Name:FOX
Suffix:
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 RIBAUT ROAD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902
Mailing Address - Country:US
Mailing Address - Phone:843-525-6228
Mailing Address - Fax:
Practice Address - Street 1:960 RIBAUT ROAD
Practice Address - Street 2:SUITE #2
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902
Practice Address - Country:US
Practice Address - Phone:843-525-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC95531223X0400X
SC96811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics