Provider Demographics
NPI:1932276342
Name:BRIAN C FOOTE DMD PC
Entity Type:Organization
Organization Name:BRIAN C FOOTE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-295-6002
Mailing Address - Street 1:BOX 388
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571
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
Practice Address - Country:US
Practice Address - Phone:508-295-6002
Practice Address - Fax:508-295-1543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty