MEDICARE: DR. JONATHAN G. FOSHAY DMD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7654	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1488456	OTHER		UNITED CONCORDIA
2	197171	OTHER	OR	CAPITOL DENTAL CARE
3	297171	OTHER	OR	ODS - OHP

General Provider Information

NPI Number	:	1053421966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN G. FOSHAY DMD, PC

Provider Business Mailing Address
First Line	:	94026 RIVER RD
Second Line	:
City	:	JUNCTION CITY
State	:	OR
Zip	:	97448-9414
Country	:	US
Telephone Number	:	541-998-6252
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 JUNIPER ST
Second Line	:
City	:	JUNCTION CITY
State	:	OR
Zip	:	97448-1935
Country	:	US
Telephone Number	:	541-998-6252
Fax Number	:	541-998-7576

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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