Healthcare Provider Details

I. General information

NPI: 1043448780
Provider Name (Legal Business Name): JOHN H FOLEY DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 GIDDINGS ST
RALEIGH NC
27616-6685
US

IV. Provider business mailing address

6440 GIDDINGS ST
RALEIGH NC
27616-6685
US

V. Phone/Fax

Practice location:
  • Phone: 847-833-5365
  • Fax:
Mailing address:
  • Phone: 847-833-5365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10203
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: