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General NPI Number Information
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NPI Number | 1255136222
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Entity Type | Organization
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Legal Business Name | FOOTHILL ENDODONTICS LLC
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 3534 LONE PINE RD
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City | MEDFORD
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State | OR
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Zip | 97504-5637
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Country | US
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Telephone | 541-200-0321
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Fax |
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Provider Business Mailing Address
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Address Line | 3534 LONE PINE RD
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City | MEDFORD
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State | OR
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Zip | 97504-5637
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Country | US
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Telephone | 541-200-0321
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRYCE TAYLOR
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Credential | DDS
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Telephone | 312-925-9311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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