Provider Demographics
NPI:1053421966
Name:FOSHAY, JONATHAN G (DMD, PC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:G
Last Name:FOSHAY
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94026 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-9414
Mailing Address - Country:US
Mailing Address - Phone:541-998-6252
Mailing Address - Fax:
Practice Address - Street 1:1021 JUNIPER ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:OR
Practice Address - Zip Code:97448-1935
Practice Address - Country:US
Practice Address - Phone:541-998-6252
Practice Address - Fax:541-998-7576
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR76541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1488456OtherUNITED CONCORDIA
OR197171OtherCAPITOL DENTAL CARE
OR297171OtherODS - OHP