=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356746119
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARISA H. FOX, DDS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2014
-----------------------------------------------------
Last Update Date | 10/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7900 SHIN OAK DR
-----------------------------------------------------
City | LIVE OAK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78233-2411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-654-1851
-----------------------------------------------------
Fax | 210-654-3078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 715 VEGAS RIO
-----------------------------------------------------
City | HELOTES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78023-4639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-520-3841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARISA HWA FOX
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 210-520-3841
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 16509
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------