Provider Demographics
NPI:1598704165
Name:FOX, DWIGHT (DMD)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:
Last Name:FOX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:STONEBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16153-3328
Mailing Address - Country:US
Mailing Address - Phone:412-327-6407
Mailing Address - Fax:
Practice Address - Street 1:262 BROWN RD
Practice Address - Street 2:
Practice Address - City:STONEBORO
Practice Address - State:PA
Practice Address - Zip Code:16153-3328
Practice Address - Country:US
Practice Address - Phone:412-327-6407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021350L1223G0001X
WV3934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA05412520003Medicare ID - Type Unspecified