Provider Demographics
NPI:1487852547
Name:FOREMAN, MICHAEL CARRAWAY (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CARRAWAY
Last Name:FOREMAN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2589
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32056-2589
Mailing Address - Country:US
Mailing Address - Phone:386-755-8833
Mailing Address - Fax:
Practice Address - Street 1:239 SW PROFESSIONAL GLN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-1105
Practice Address - Country:US
Practice Address - Phone:386-755-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN170841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics