Provider Demographics
NPI:1629262761
Name:FOULKES, DAVID JONES (DAVID FOULKES)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JONES
Last Name:FOULKES
Suffix:
Gender:M
Credentials:DAVID FOULKES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 N FOREST HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-8938
Mailing Address - Country:US
Mailing Address - Phone:608-752-4732
Mailing Address - Fax:
Practice Address - Street 1:4425 N FOREST HILLS BLVD
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-8938
Practice Address - Country:US
Practice Address - Phone:608-752-4732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000628-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist