MEDICARE: DR. DWIGHT FOX DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS021350L	PA
2	122300000X	Dentist	3934	WV

General Provider Information

NPI Number	:	1598704165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWIGHT FOX DMD

Provider Business Mailing Address
First Line	:	262 BROWN RD
Second Line	:
City	:	STONEBORO
State	:	PA
Zip	:	16153-3328
Country	:	US
Telephone Number	:	412-327-6407
Fax Number	:

Provider Business Practice Location Address
First Line	:	262 BROWN RD
Second Line	:
City	:	STONEBORO
State	:	PA
Zip	:	16153-3328
Country	:	US
Telephone Number	:	412-327-6407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	08/30/2016

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