Healthcare Provider Details

I. General information

NPI: 1396323804
Provider Name (Legal Business Name): TRAYVON EDWARD FOY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC STREET HSB ROOM 241
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1959 NE PACIFIC STREET HSB ROOM 241
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-7496
  • Fax: 206-685-7222
Mailing address:
  • Phone: 206-543-7496
  • Fax: 206-685-7222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDR61248195
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDR61164248
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: