Healthcare Provider Details

I. General information

NPI: 1568504355
Provider Name (Legal Business Name): ERIC M. FOSS, D.D.S., M.S., P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 WEST DR SUITE 160
CHESTERFIELD MO
63017-1793
US

IV. Provider business mailing address

4 WEST DR SUITE 160
CHESTERFIELD MO
63017-1793
US

V. Phone/Fax

Practice location:
  • Phone: 636-778-9901
  • Fax: 636-778-9904
Mailing address:
  • Phone: 636-778-9901
  • Fax: 636-778-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2005015009
License Number StateMO

VIII. Authorized Official

Name: DR. ERIC M. FOSS
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 636-778-9901