Provider Demographics
NPI:1447380811
Name:FOX VALLEY DENTAL ASSOC. LTD.
Entity type:Organization
Organization Name:FOX VALLEY DENTAL ASSOC. LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPRINGBORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-735-9366
Mailing Address - Street 1:2315 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-4178
Mailing Address - Country:US
Mailing Address - Phone:920-735-9366
Mailing Address - Fax:
Practice Address - Street 1:2315 W MAIN ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-4178
Practice Address - Country:US
Practice Address - Phone:920-735-9366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0570G1223G0001X
WI4049.0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty