Provider Demographics
NPI:1336466358
Name:FOUST, ROSCOE T IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSCOE
Middle Name:T
Last Name:FOUST
Suffix:IV
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:CADE
Other - Middle Name:
Other - Last Name:FOUST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:21715 KINGSLAND BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2544
Mailing Address - Country:US
Mailing Address - Phone:832-600-6878
Mailing Address - Fax:888-565-5188
Practice Address - Street 1:21715 KINGSLAND BLVD STE 105
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2544
Practice Address - Country:US
Practice Address - Phone:832-600-6878
Practice Address - Fax:888-565-5188
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2012-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice