MEDICARE: WILLIAM DRAYSON FOXCROFT

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	D-5621	ID

General Provider Information

NPI Number	:	1356193999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM DRAYSON FOXCROFT

Provider Business Mailing Address
First Line	:	13288 W SATINLEAF DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-1992
Country	:	US
Telephone Number	:	408-833-3173
Fax Number	:

Provider Business Practice Location Address
First Line	:	4274 N EAGLE RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-0726
Country	:	US
Telephone Number	:	408-833-3173
Fax Number	:

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

Provider Enumeration Date	:	04/05/2024
Last Update Date	:	05/30/2024

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