Healthcare Provider Details

I. General information

NPI: 1811826654
Provider Name (Legal Business Name): DR. LEIA AHAVA FOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 ARMOUR RD STE B
OCONOMOWOC WI
53066-3976
US

IV. Provider business mailing address

1500 SYLVAN ST UNIT 113
OCONOMOWOC WI
53066-1338
US

V. Phone/Fax

Practice location:
  • Phone: 262-569-4990
  • Fax:
Mailing address:
  • Phone: 248-885-9109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6002137-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: