Provider Demographics
NPI:1568454726
Name:FOULK, BRYAN RICHARD (DMD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:RICHARD
Last Name:FOULK
Suffix:
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 1:7229 N THORNYDALE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2086
Mailing Address - Country:US
Mailing Address - Phone:520-744-3480
Mailing Address - Fax:520-744-3473
Practice Address - Street 1:7229 N THORNYDALE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2097
Practice Address - Country:US
Practice Address - Phone:520-744-3480
Practice Address - Fax:520-744-3473
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice