Provider Demographics
NPI:1811120728
Name:FOX, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:FOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 SW 10TH AVE, STE 810
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3485
Mailing Address - Country:US
Mailing Address - Phone:503-223-5039
Mailing Address - Fax:503-223-1123
Practice Address - Street 1:511 SW 10TH AVE, STE 810
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3485
Practice Address - Country:US
Practice Address - Phone:503-223-5039
Practice Address - Fax:503-223-1123
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD98601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics