Provider Demographics
NPI:1215910930
Name:FOX, JULIE RACHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:RACHELLE
Last Name:FOX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4240
Mailing Address - Country:US
Mailing Address - Phone:321-727-8822
Mailing Address - Fax:321-727-0074
Practice Address - Street 1:401 5TH AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4240
Practice Address - Country:US
Practice Address - Phone:321-727-8822
Practice Address - Fax:321-727-0074
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 18372122300000X
OH30022159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OTHMedicare UPIN