Provider Demographics
NPI:1235384868
Name:GREGORY J FOLSE DDS LTD A DENTAL CORPORATION
Entity Type:Organization
Organization Name:GREGORY J FOLSE DDS LTD A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOLSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:800-409-2563
Mailing Address - Street 1:2550 W UNION HILLS DR
Mailing Address - Street 2:2012
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5163
Mailing Address - Country:US
Mailing Address - Phone:800-409-2563
Mailing Address - Fax:623-321-6268
Practice Address - Street 1:510 GUILBEAU RD
Practice Address - Street 2:C
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-8400
Practice Address - Country:US
Practice Address - Phone:800-409-2563
Practice Address - Fax:623-321-6268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA44231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty