Provider Demographics
NPI:1295725166
Name:FOREMAN, RICHARD L (DMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:FOREMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 CHAMPLAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROUSES POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12979-1505
Mailing Address - Country:US
Mailing Address - Phone:518-297-8110
Mailing Address - Fax:
Practice Address - Street 1:78 CHAMPLAIN ST
Practice Address - Street 2:
Practice Address - City:ROUSES POINT
Practice Address - State:NY
Practice Address - Zip Code:12979-1505
Practice Address - Country:US
Practice Address - Phone:518-297-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0368831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice