Basic Information
| Provider Information | |||||||||
| NPI: | 1316347636 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOULK | ||||||||
| FirstName: | R | ||||||||
| MiddleName: | CAMERON | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59 DAMONTE RANCH PKWY | ||||||||
| Address2: | F | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895211907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758512204 | ||||||||
| FaxNumber: | 7758512214 | ||||||||
| Practice Location | |||||||||
| Address1: | 59 DAMONTE RANCH PKWY | ||||||||
| Address2: | F | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895211907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758512204 | ||||||||
| FaxNumber: | 7758512214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2014 | ||||||||
| LastUpdateDate: | 08/25/2014 | ||||||||
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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 | 1223G0001X | 6527 | NV | Y | Dental Providers | Dentist | General Practice |
No ID Information.