MEDICARE: FREDERIC FOLTZ DDS

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	122300000X	Dentist	18326	OH

General Provider Information

NPI Number	:	1427176684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERIC FOLTZ DDS

Provider Business Mailing Address
First Line	:	271 CLINE AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-1042
Country	:	US
Telephone Number	:	419-756-2255
Fax Number	:

Provider Business Practice Location Address
First Line	:	271 CLINE AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-1042
Country	:	US
Telephone Number	:	419-756-2255
Fax Number	:

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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