Provider Demographics
NPI:1861464125
Name:FOOTE, BRYAN GRAHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:GRAHAM
Last Name:FOOTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W NIFONG
Mailing Address - Street 2:STE 4A
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203
Mailing Address - Country:US
Mailing Address - Phone:573-449-2311
Mailing Address - Fax:573-449-8715
Practice Address - Street 1:601 W NIFONG
Practice Address - Street 2:STE 4A
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203
Practice Address - Country:US
Practice Address - Phone:573-449-2311
Practice Address - Fax:573-449-8715
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist