1578697918 NPI number — DR. RUSSELL BARRY FOX DMD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578697918 NPI number — DR. RUSSELL BARRY FOX DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOX
Provider First Name:
RUSSELL
Provider Middle Name:
BARRY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578697918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/08/2017
NPI Reactivation Date:
09/20/2017

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
299 SOUTH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWELL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-659-3444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 HANCOCK STREET
Provider Second Line Business Practice Location Address:
FLOOR 1
Provider Business Practice Location Address City Name:
NORTH QUINCY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-471-5255
Provider Business Practice Location Address Fax Number:
617-774-6468
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  17399 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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