=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407024847
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M. JOSEPH FOX, D.D.S., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2008
-----------------------------------------------------
Last Update Date | 07/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2521 BURNS RD
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-5204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-694-0038
-----------------------------------------------------
Fax | 561-694-0990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2521 BURNS RD
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-5204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-694-0038
-----------------------------------------------------
Fax | 561-694-0990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. M. JOSEPH FOX
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 561-694-0038
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 4296
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------