Provider Demographics
NPI:1699892505
Name:FOX, ROBERT BLAIR (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BLAIR
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 1:6410 THORNBERRY CT. #D
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040
Mailing Address - Country:US
Mailing Address - Phone:513-398-3322
Mailing Address - Fax:
Practice Address - Street 1:6410 THORNBERRY CT. #D
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:513-398-3322
Practice Address - Fax:513-398-9088
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0144991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311048900OtherTAX ID