MEDICARE: DR. BENJAMIN L FOULK DDS

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	1223G0001X	General Practice Dentistry	21453	CA

General Provider Information

NPI Number	:	1770841512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN L FOULK DDS

Provider Business Mailing Address
First Line	:	4354 TOWN CENTER BLVD
Second Line	:	SUITE 11450
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-7116
Country	:	US
Telephone Number	:	916-933-6600
Fax Number	:	916-939-1692

Provider Business Practice Location Address
First Line	:	1011 SAINT ANDREWS DR
Second Line	:	SUITE A
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-4248
Country	:	US
Telephone Number	:	916-933-6600
Fax Number	:	916-939-1692

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

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	04/30/2012

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