MEDICARE: RUSSELL B. FOX, D.M.D. PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	DN17399	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1578697918	OTHER	MA	PRIOR NPI #

General Provider Information

NPI Number	:	1003337957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSSELL B. FOX, D.M.D. PC

Provider Business Mailing Address
First Line	:	PO BOX 873
Second Line	:
City	:	NORWELL
State	:	MA
Zip	:	02061-0873
Country	:	US
Telephone Number	:	781-738-6631
Fax Number	:

Provider Business Practice Location Address
First Line	:	259 CENTRE ST
Second Line	:
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-2234
Country	:	US
Telephone Number	:	781-738-6631
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RUSSELL BARRY FOX
Credential	:	DMD
Telephone Number	:	781-738-6631

Provider Enumeration Date	:	06/30/2017
Last Update Date	:	06/16/2018

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