MEDICARE: WILLIAM JACOB FOOKS DMD

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	30.027019	OH
2	122300000X	Dentist	10790	KY

General Provider Information

NPI Number	:	1730814146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JACOB FOOKS DMD

Provider Business Mailing Address
First Line	:	5221 WAYNETOWNE CT
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-2124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 ALEXANDRIA PIKE STE 100
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-2169
Country	:	US
Telephone Number	:	859-781-0221
Fax Number	:

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

Provider Enumeration Date	:	07/19/2022
Last Update Date	:	10/09/2023

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