MEDICARE: FOX KIDS DENTISTRY & ORTHODONTICS II

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1700374154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOX KIDS DENTISTRY & ORTHODONTICS II

Provider Business Mailing Address
First Line	:	1401 SE MORRISON ST STE 120
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-2777
Country	:	US
Telephone Number	:	503-477-9911
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 SE MORRISON ST STE 120
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-2777
Country	:	US
Telephone Number	:	503-477-9911
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. DANA FOX
Credential	:	DMD
Telephone Number	:	503-223-5039

Provider Enumeration Date	:	05/01/2018
Last Update Date	:	05/01/2018

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