Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 536084 | OR |
NPI | 1164611901 |
---|---|
Provider Name | Mr. William A. Foster JR. |
First Address | Florence, OR 97439-0051 |
Second Address | Florence, OR 97439-9359 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2007 |
Last Update Date | 25/02/2021 |