Provider Demographics
NPI:1568504355
Name:ERIC M. FOSS, D.D.S., M.S., P. C.
Entity Type:Organization
Organization Name:ERIC M. FOSS, D.D.S., M.S., P. C.
Other - Org Name:ST. LOUIS COUNTY ENDODONTICS, LTD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-778-9901
Mailing Address - Street 1:4 WEST DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1793
Mailing Address - Country:US
Mailing Address - Phone:636-778-9901
Mailing Address - Fax:636-778-9904
Practice Address - Street 1:4 WEST DR
Practice Address - Street 2:SUITE 160
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-1793
Practice Address - Country:US
Practice Address - Phone:636-778-9901
Practice Address - Fax:636-778-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050150091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty