Provider Demographics
NPI:1265697031
Name:JOHN M FOX DENTISTRY
Entity type:Organization
Organization Name:JOHN M FOX DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-337-7338
Mailing Address - Street 1:201 S HIGH ST
Mailing Address - Street 2:P.O. BOX 26
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-2406
Mailing Address - Country:US
Mailing Address - Phone:423-337-7338
Mailing Address - Fax:423-337-8244
Practice Address - Street 1:201 S HIGH ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-2406
Practice Address - Country:US
Practice Address - Phone:423-337-7338
Practice Address - Fax:423-337-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS4654122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty