Provider Demographics
NPI:1073666350
Name:FOUST, AMANDA JILL (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JILL
Last Name:FOUST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SE ORALABOR RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-9104
Mailing Address - Country:US
Mailing Address - Phone:515-965-0230
Mailing Address - Fax:515-965-2484
Practice Address - Street 1:205 SE ORALABOR RD
Practice Address - Street 2:SUITE E
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-9104
Practice Address - Country:US
Practice Address - Phone:515-965-0230
Practice Address - Fax:515-965-2484
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice