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General NPI Number Information
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NPI Number | 1952432411
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Entity Type | Organization
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Legal Business Name | FOX PEDIATRIC & ADOLESCENT DENTISTRY, P.C.
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 546 S BROAD ST SUITE 2D
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City | MERIDEN
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State | CT
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Zip | 06450-6600
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Country | US
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Telephone | 203-886-0028
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Fax | 203-886-0035
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Provider Business Mailing Address
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Address Line | 546 S BROAD ST SUITE 2D
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City | MERIDEN
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State | CT
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Zip | 06450-6600
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Country | US
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Telephone | 203-886-0028
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Fax | 203-886-0035
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN NILES FOX
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Credential | D.M.D.
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Telephone | 203-886-0028
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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 | 4703
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License Number State | CT
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