MEDICARE: DR. JOHN S FOSS D.D.S, M.D.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D11925	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	86-00416	OTHER	MN	MEDICA MNCARE-BRAINERD
3	86-00422	OTHER	MN	MEDICA MNCARE-LITTLE FALL
4	271L4-FO	OTHER	MN	BLUE PLUS
5	9177849	OTHER	MN	DORAL DENTAL
6	86-00424	OTHER	MN	MEDICA MNCARE-BEMIDJI
7	132284	OTHER	MN	UCARE
8	86-00425	OTHER	MN	MEDICA MNCARE-DETROIT LAK

General Provider Information

NPI Number	:	1184604464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN S FOSS D.D.S, M.D.

Provider Business Mailing Address
First Line	:	1903 S 6TH ST
Second Line	:
City	:	BRAINERD
State	:	MN
Zip	:	56401-4599
Country	:	US
Telephone Number	:	218-829-1728
Fax Number	:	218-829-1729

Provider Business Practice Location Address
First Line	:	1903 S 6TH ST
Second Line	:
City	:	BRAINERD
State	:	MN
Zip	:	56401-4599
Country	:	US
Telephone Number	:	218-829-1728
Fax Number	:	218-829-1729

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	01/13/2011

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Directions to “ DR. JOHN S FOSS D.D.S, M.D.” Practice Location

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