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General NPI Number Information
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NPI Number | 1063150365
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Entity Type | Individual
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Provider Name | JEANA LEE FOSTER RDH
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Gender | Female
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Dates
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Enumeration Date | 05/25/2022
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 1845 HOLSONBACK DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5114
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Country | US
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Telephone | 386-281-6370
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Fax |
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Provider Business Mailing Address
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Address Line | 1677 NEW TOWN TER
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City | PORT ORANGE
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State | FL
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Zip | 32129-7533
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Country | US
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Telephone | 386-843-1313
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH9261
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License Number State | FL
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