Provider Demographics
NPI:1871884189
Name:FOX, MAYNARD JOSEPH
Entity type:Individual
Prefix:DR
First Name:MAYNARD
Middle Name:JOSEPH
Last Name:FOX
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:M
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS,PA
Mailing Address - Street 1:1220 NE 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-4930
Mailing Address - Country:US
Mailing Address - Phone:352-732-4847
Mailing Address - Fax:
Practice Address - Street 1:1220 NE 36TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-4931
Practice Address - Country:US
Practice Address - Phone:352-732-4847
Practice Address - Fax:352-351-3202
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN42961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice