Healthcare Provider Details

I. General information

NPI: 1508965302
Provider Name (Legal Business Name): DR. KARL J FOOSE DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 SOUTH DIXIE HIGHWAY SUITE A
WEST PALM BEACH FL
33405-2647
US

IV. Provider business mailing address

4100 SOUTH DIXIE HIGHWAY SUITE A
WEST PALM BEACH FL
33405-2647
US

V. Phone/Fax

Practice location:
  • Phone: 561-655-3404
  • Fax:
Mailing address:
  • Phone: 561-655-3404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN 2313
License Number StateFL

VIII. Authorized Official

Name: DR. KARL JOSEF FOOSE
Title or Position: OWNER
Credential: DDS
Phone: 561-655-3404