Healthcare Provider Details

I. General information

NPI: 1457364374
Provider Name (Legal Business Name): FOOTE & FOOTE, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4213 N CHURCH WAY
LOUISVILLE KY
40207-3926
US

IV. Provider business mailing address

4213 N CHURCH WAY
LOUISVILLE KY
40207-3926
US

V. Phone/Fax

Practice location:
  • Phone: 502-896-8669
  • Fax:
Mailing address:
  • Phone: 502-896-8669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3958
License Number StateKY

VIII. Authorized Official

Name: DR. JOHN CHARLES FOOTE
Title or Position: OWNER
Credential: D.M.D.
Phone: 502-896-8669