Provider Demographics
NPI:1255337481
Name:FOX, JOHN P (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:FOX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:671 LUMPKIN CAMPGROUND RD S
Mailing Address - Street 2:STE 110
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-0931
Mailing Address - Country:US
Mailing Address - Phone:706-265-1700
Mailing Address - Fax:706-265-1702
Practice Address - Street 1:671 LUMPKIN CAMPGROUND RD S
Practice Address - Street 2:STE 110
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-0931
Practice Address - Country:US
Practice Address - Phone:706-265-1700
Practice Address - Fax:706-265-1702
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0124741223S0112X
MI29010158181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00940794CMedicaid
GA19NCCCHMedicare ID - Type Unspecified