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General NPI Number Information
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NPI Number | 1295462802
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Entity Type | Organization
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Legal Business Name | FOX PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 400 SOUTH RANDALL ROAD SUITE F AND G
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City | ELGIN
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State | IL
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Zip | 60123
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Country | US
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Telephone | 847-372-5818
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Fax |
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Provider Business Mailing Address
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Address Line | 739 W BELMONT AVE APT 416
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City | CHICAGO
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State | IL
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Zip | 60657-4561
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Country | US
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Telephone | 847-372-5818
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. JUSTIN J BAIK
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Credential | DMD
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Telephone | 847-372-5818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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