Healthcare Provider Details

I. General information

NPI: 1184073330
Provider Name (Legal Business Name): FOX DENTAL - MEDFORD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1293 E MCANDREWS RD
MEDFORD OR
97504-6103
US

IV. Provider business mailing address

1293 E MCANDREWS RD
MEDFORD OR
97504-6103
US

V. Phone/Fax

Practice location:
  • Phone: 541-772-1215
  • Fax:
Mailing address:
  • Phone: 541-772-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: ADAM FOX
Title or Position: DENTIST
Credential: DMD
Phone: 541-772-1215