Provider Demographics
NPI:1770694911
Name:FOX VIEW DENTAL SC
Entity type:Organization
Organization Name:FOX VIEW DENTAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BASTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-336-4201
Mailing Address - Street 1:2310 OAK RIDGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115
Mailing Address - Country:US
Mailing Address - Phone:920-336-4201
Mailing Address - Fax:920-336-0340
Practice Address - Street 1:2310 OAK RIDGE CIRCLE
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115
Practice Address - Country:US
Practice Address - Phone:920-336-4201
Practice Address - Fax:920-336-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty