MEDICARE: DR. DAVID M. FOLLIS 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	12010354A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457345688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID M. FOLLIS D.D.S.

Provider Business Mailing Address
First Line	:	21061 QUIET RIDGE CT
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46614-5181
Country	:	US
Telephone Number	:	574-514-8746
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 LINCOLN WAY E
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46613-3250
Country	:	US
Telephone Number	:	574-232-8888
Fax Number	:	574-232-8929

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	05/28/2014

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