Provider Demographics
NPI:1952432411
Name:FOX PEDIATRIC & ADOLESCENT DENTISTRY, P.C.
Entity Type:Organization
Organization Name:FOX PEDIATRIC & ADOLESCENT DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:NILES
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-886-0028
Mailing Address - Street 1:546 S BROAD ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6600
Mailing Address - Country:US
Mailing Address - Phone:203-886-0028
Mailing Address - Fax:203-886-0035
Practice Address - Street 1:546 S BROAD ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6600
Practice Address - Country:US
Practice Address - Phone:203-886-0028
Practice Address - Fax:203-886-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT47031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty