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General NPI Number Information
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NPI Number | 1740560739
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Entity Type | Organization
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Legal Business Name | BEACH DENTAL GROUP INC
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 08/22/2011
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Provider Practice Location Address
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Address Line | 34 DORMER DR
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City | ORMOND BEACH
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State | FL
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Zip | 32174-1051
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Country | US
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Telephone | 386-428-6491
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Fax |
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Provider Business Mailing Address
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Address Line | 809 STATE ROAD 44
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-7271
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Country | US
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Telephone | 386-428-6491
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | DR. FREDERICK A FOX
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Credential | DENTIS
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Telephone | 386-428-6491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN15016
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License Number State | FL
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