MEDICARE: DR. CRAIG LOYD FOLSOM D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	38680	CA

General Provider Information

NPI Number	:	1023007846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG LOYD FOLSOM D.D.S.

Provider Business Mailing Address
First Line	:	90 HOPE DR BLDG 6000
Second Line	:
City	:	MOUNTAIN HOME AFB
State	:	ID
Zip	:	83648-1062
Country	:	US
Telephone Number	:	208-828-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 HOPE DR BLDG 6000
Second Line	:
City	:	MOUNTAIN HOME AFB
State	:	ID
Zip	:	83648
Country	:	US
Telephone Number	:	208-828-7300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	05/23/2018

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