Basic Information
| Provider Information | |||||||||
| NPI: | 1013015452 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOREMAN | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 387 NE 223RD AVE | ||||||||
| Address2: | |||||||||
| City: | GRESHAM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970308554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036252538 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 387 NE 223RD AVE | ||||||||
| Address2: | |||||||||
| City: | GRESHAM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970308554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036252538 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 01/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | DE00007037 | WA | N | Dental Providers | Dentist | Pediatric Dentistry | 1223P0221X | D10202 | OR | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.