Provider Demographics
NPI:1295917300
Name:CHRISTIAN E FOLTYS DDS PC
Entity type:Organization
Organization Name:CHRISTIAN E FOLTYS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:FOLTYS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-722-1011
Mailing Address - Street 1:1520 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60433
Mailing Address - Country:US
Mailing Address - Phone:815-722-1011
Mailing Address - Fax:
Practice Address - Street 1:24600 SOUTH ROUTE 52
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:IL
Practice Address - Zip Code:60442
Practice Address - Country:US
Practice Address - Phone:815-478-9891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty