Provider Demographics
NPI:1013015452
Name:FOREMAN, FRANK JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:JAMES
Last Name:FOREMAN
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 1:387 NE 223RD AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8554
Mailing Address - Country:US
Mailing Address - Phone:503-625-2538
Mailing Address - Fax:
Practice Address - Street 1:387 NE 223RD AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8554
Practice Address - Country:US
Practice Address - Phone:503-625-2538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000070371223P0221X
ORD102021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5050737Medicare ID - Type Unspecified