Provider Demographics
NPI:1396931192
Name:FOOTE, BRIAN CHARLES (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHARLES
Last Name:FOOTE
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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-0388
Mailing Address - Country:US
Mailing Address - Phone:508-295-6002
Mailing Address - Fax:508-295-1543
Practice Address - Street 1:45 MAIN ST
Practice Address - Street 2:C-6
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2170
Practice Address - Country:US
Practice Address - Phone:508-295-6002
Practice Address - Fax:508-295-1543
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-15
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice