Provider Demographics
NPI:1851708366
Name:FOREMAN, CLAIRE NICOLE (DDS)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:NICOLE
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9712 MCKNIGHT LOOP
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4668
Mailing Address - Country:US
Mailing Address - Phone:847-271-7720
Mailing Address - Fax:
Practice Address - Street 1:6012 W WILLIAM CANNON DR STE B102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1978
Practice Address - Country:US
Practice Address - Phone:847-271-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029839122300000X
TX369581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist