Provider Demographics
NPI:1417097999
Name:FOULK, DAVID WENDELL (DDS,PC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WENDELL
Last Name:FOULK
Suffix:
Gender:M
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MEMORIAL BLVD
Mailing Address - Street 2:P.O. BOX 3470
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-3341
Mailing Address - Country:US
Mailing Address - Phone:423-378-4488
Mailing Address - Fax:423-230-2293
Practice Address - Street 1:2300 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-3341
Practice Address - Country:US
Practice Address - Phone:423-378-4488
Practice Address - Fax:423-230-2293
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000023651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN450471663OtherTAX ID NUMBER