Provider Demographics
NPI:1700374154
Name:FOX KIDS DENTISTRY & ORTHODONTICS II
Entity Type:Organization
Organization Name:FOX KIDS DENTISTRY & ORTHODONTICS II
Other - Org Name:SPROUT PEDIATRIC DENTISTRY & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-223-5039
Mailing Address - Street 1:1401 SE MORRISON ST STE 120
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2777
Mailing Address - Country:US
Mailing Address - Phone:503-477-9911
Mailing Address - Fax:
Practice Address - Street 1:1401 SE MORRISON ST STE 120
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2777
Practice Address - Country:US
Practice Address - Phone:503-477-9911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty