Robert A Fozkos, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12013333A Issued in IN

Practice address

1003 W Toledo St
Fremont, IN 46737-2075

Phone

(570) 654-4141

NPI assigned

Jul 25, 2018

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Casey Dental Institute P.C.

  • General Practice Dentistry
  • Pittston Township, PA
  • NPI 1417192725

  General Practice

  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 18, 2024.

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1992282768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "882 MEADOWDALE CT",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463839742",
            "telephone_number": "219-510-2286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 W TOLEDO ST",
            "city": "FREMONT",
            "state": "IN",
            "postal_code": "467372075",
            "telephone_number": "570-654-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOZKOS",
        "first_name": "ROBERT",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-25",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS041878",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12013333A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cameron Memorial Community Hospital Inc
• Brandy Chipman
• Lydia Clark
• Diane R Crisman, M.A.T. C.C.C.-SP
• Ted J. Crisman, MD
• Fremont Community Schools
• Fremont Family Dentistry, P.C.
• Alexandra Marie Friend
• Full Potential. Inc
• Terri Gauvey Hague, RPH

• All providers in Fremont, IN
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.