Healthcare Provider Details

I. General information

NPI: 1699694539
Provider Name (Legal Business Name): MOLLY FOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E JACKSON BLVD
ELKHART IN
46516-3514
US

IV. Provider business mailing address

14745 COUNTY MURRAY DR
GRANGER IN
46530-7375
US

V. Phone/Fax

Practice location:
  • Phone: 574-564-6049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12015098A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: