Provider Demographics
NPI:1407377724
Name:FOREMAN, KATHLEEN E
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14560 S MILITARY TRL STE B2
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-3794
Mailing Address - Country:US
Mailing Address - Phone:561-323-7264
Mailing Address - Fax:
Practice Address - Street 1:10457 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5645
Practice Address - Country:US
Practice Address - Phone:772-446-4816
Practice Address - Fax:772-777-2734
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN227041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice