MEDICARE: DR. ROBERT G. 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	12266	MO

General Provider Information

NPI Number	:	1457353740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT G. FOX D.D.S.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/09/2007

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