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NPI Code Detail

MEDICARE: FOX FAMILY DENTAL LLC

MEDICARE: FOX FAMILY DENTAL LLC
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1134590961
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOX FAMILY DENTAL LLC
Provider Business Mailing Address
First Line : 832 N KINGSHIGHWAY ST
Second Line :
City : CAPE GIRARDEAU
State : MO
Zip : 63701-4316
Country : US
Telephone Number : 573-334-8431
Fax Number : 573-334-7631
Provider Business Practice Location Address
First Line : 832 N KINGSHIGHWAY ST
Second Line :
City : CAPE GIRARDEAU
State : MO
Zip : 63701-4316
Country : US
Telephone Number : 573-334-8431
Fax Number : 573-334-7631
Authorized Official
Title or Position : PRACTICE MANAGER
Name : AMBER L NEWCOMB
Credential : RDH
Telephone Number : 573-334-8431
Provider Enumeration Date : 10/20/2015
Last Update Date : 10/20/2015

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Directions to “FOX FAMILY DENTAL LLC ” Practice Location

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