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General NPI Number Information
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NPI Number | 1770841512
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Entity Type | Individual
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Provider Name | BENJAMIN L FOULK DDS
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Gender | Male
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 1011 SAINT ANDREWS DR SUITE A
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-4248
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Country | US
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Telephone | 916-933-6600
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Fax | 916-939-1692
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Provider Business Mailing Address
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Address Line | 4354 TOWN CENTER BLVD SUITE 11450
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-7116
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Country | US
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Telephone | 916-933-6600
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Fax | 916-939-1692
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 21453
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License Number State | CA
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