MEDICARE: DR. BRUCE 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DI-14106	NJ

General Provider Information

NPI Number	:	1609917517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE FOX D.D.S.

Provider Business Mailing Address
First Line	:	3155 STATE ROUTE 10
Second Line	:	SUITE 111
City	:	DENVILLE
State	:	NJ
Zip	:	07834-3492
Country	:	US
Telephone Number	:	973-328-4434
Fax Number	:	973-328-8898

Provider Business Practice Location Address
First Line	:	3155 STATE ROUTE 10
Second Line	:	SUITE 111
City	:	DENVILLE
State	:	NJ
Zip	:	07834-3492
Country	:	US
Telephone Number	:	973-328-4434
Fax Number	:	973-328-8898

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. BRUCE FOX D.D.S.” Practice Location

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