Walter Fombin Foto, BDS DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

8264 Issued in WA

Practice address

4202 10TH St SE # 101
Puyallup, WA 98374-2191

Phone

(253) 272-7574

Fax

(253) 272-9044

NPI assigned

Sep 26, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1215038716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4202 10TH ST SE STE 311",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983742191",
            "telephone_number": "253-272-7574",
            "fax_number": "253-272-9044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4202 10TH ST SE # 101",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983742191",
            "telephone_number": "253-272-7574",
            "fax_number": "253-272-9044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "814 6th Ave",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984054501",
            "country_code": "US",
            "telephone_number": "253-272-7574",
            "fax_number": "253-272-9044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOTO",
        "first_name": "WALTER",
        "middle_name": "FOMBIN",
        "name_prefix": "Dr.",
        "credential": "BDS DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "8264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Clifton Fortney Jr.
• Erin Foster
• Jessica Lee Foster, ARNP, FNP-BC
• Madasen Foster, LMT
• Mylene Foster, RPT
• Barbara Anne Fournier
• Dustin Leigh Fowler, PSY.D., M.A., M.S.
• Barbara J Fox, MD
• Ewing Fox, LPTA
• La Vonne Fox

• Oral and Maxillofacial Surgery (Dentist) in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.