Provider Demographics
NPI:1043271695
Name:FOULK-MANELA, PC
Entity type:Organization
Organization Name:FOULK-MANELA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOULK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:520-744-3480
Mailing Address - Street 1:7229 N THORNYDALE RD
Mailing Address - Street 2:STE. 149
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2097
Mailing Address - Country:US
Mailing Address - Phone:520-744-3480
Mailing Address - Fax:520-744-3473
Practice Address - Street 1:7229 N THORNYDALE RD
Practice Address - Street 2:STE. 149
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2097
Practice Address - Country:US
Practice Address - Phone:520-744-3480
Practice Address - Fax:520-744-3473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty