MEDICARE: KATHERINE M FOX D.D.S.

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	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1326119835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE M FOX D.D.S.

Provider Business Mailing Address
First Line	:	109 N CHESTNUT ST
Second Line	:	PO BOX 141
City	:	ONARGA
State	:	IL
Zip	:	60955-1255
Country	:	US
Telephone Number	:	815-268-7779
Fax Number	:	815-268-4607

Provider Business Practice Location Address
First Line	:	109 N CHESTNUT ST
Second Line	:
City	:	ONARGA
State	:	IL
Zip	:	60955-1255
Country	:	US
Telephone Number	:	815-268-7779
Fax Number	:	815-268-4607

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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