Foundation Dental, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

020417 Issued in PA

Legal business name

FOUNDATION DENTAL, INC.

Practice address

309 S Chapel St
Louisville, OH 44641-1612

Phone

(330) 875-2200

Fax

(330) 875-2403

NPI assigned

Aug 13, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Steven Frederick Peters, D.M.D.

Title

Owner

Phone

(330) 875-2200

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1218585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224028800000",
    "number": "1376799098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 S CHAPEL ST",
            "city": "LOUISVILLE",
            "state": "OH",
            "postal_code": "446411612",
            "telephone_number": "330-875-2200",
            "fax_number": "330-875-2403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 S CHAPEL ST",
            "city": "LOUISVILLE",
            "state": "OH",
            "postal_code": "446411612",
            "telephone_number": "330-875-2200",
            "fax_number": "330-875-2403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNDATION DENTAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-13",
        "last_updated": "2008-10-15",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "FREDERICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-875-2200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "020417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2843712",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.