Provider Demographics
NPI:1326166265
Name:FOOTE, JOHN ROBERT JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:FOOTE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7348 HWY 42 SUITE #1
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042
Mailing Address - Country:US
Mailing Address - Phone:859-283-1911
Mailing Address - Fax:859-283-2218
Practice Address - Street 1:7348 US HIGHWAY 42 STE 101
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1965
Practice Address - Country:US
Practice Address - Phone:859-283-1911
Practice Address - Fax:859-283-2218
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6503122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY611244778OtherTIN