MEDICARE: MR. MICHAEL JAMES FOX DDS PC

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	014156	MO

General Provider Information

NPI Number	:	1710097258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JAMES FOX DDS PC

Provider Business Mailing Address
First Line	:	PO BOX 233
Second Line	:	205 N COMMERCIAL STE 3
City	:	SEYMOUR
State	:	MO
Zip	:	65746
Country	:	US
Telephone Number	:	417-935-2141
Fax Number	:	417-935-9991

Provider Business Practice Location Address
First Line	:	205 N COMMERCIAL ST
Second Line	:	STE 3
City	:	SEYMOUR
State	:	MO
Zip	:	65746
Country	:	US
Telephone Number	:	417-935-2141
Fax Number	:	417-935-9991

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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