Healthcare Provider Details

I. General information

NPI: 1841751252
Provider Name (Legal Business Name): RICHARD FOOTE DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 BOARDWALK
SAN MARCOS CA
92078-2607
US

IV. Provider business mailing address

909 BOARDWALK
SAN MARCOS CA
92078-2607
US

V. Phone/Fax

Practice location:
  • Phone: 775-690-6350
  • Fax:
Mailing address:
  • Phone: 775-690-6350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDDS108131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: