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General NPI Number Information
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NPI Number | 1821213620
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Entity Type | Organization
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Legal Business Name | DR JOHN N FOX DDS MS PC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1300 N WESTWOOD BLVD SUITE B
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-3314
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Country | US
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Telephone | 573-785-1466
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Fax | 573-785-8566
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Provider Business Mailing Address
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Address Line | 1300 N WESTWOOD BLVD SUITE B
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-3314
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Country | US
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Telephone | 573-785-1466
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Fax | 573-785-8566
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN NELSON FOX
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Credential | DDS MS
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Telephone | 573-785-1466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12904
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License Number State | MO
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