Individual
MARY ELISE FOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0287
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7354
LA
122300000X
Dentist
TP61089701
WA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
7354
LA
Other
Enumeration date
08/18/2020
Last updated
02/14/2023
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