Provider Demographics
NPI:1649331141
Name:FOX, DAVID MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:FOX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 E THOMAS RD
Mailing Address - Street 2:SUITE A3
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7852
Mailing Address - Country:US
Mailing Address - Phone:602-840-3391
Mailing Address - Fax:602-840-2150
Practice Address - Street 1:4855 E THOMAS RD
Practice Address - Street 2:SUITE A3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7852
Practice Address - Country:US
Practice Address - Phone:602-840-3391
Practice Address - Fax:602-840-2150
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice