Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D10202 | OR |
N | 1223P0221X | Pediatric Dentist | DE00007037 | WA |
NPI | 1013015452 |
---|---|
Provider Name | Frank James Foreman |
First Address | Gresham, OR 97030-8554 |
Second Address | Gresham, OR 97030-8554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 06/01/2016 |