Provider Demographics
NPI:1194888107
Name:DR. JEANNI R. FOSS DDS LLC
Entity type:Organization
Organization Name:DR. JEANNI R. FOSS DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DDS
Authorized Official - Prefix:
Authorized Official - First Name:JEANNI
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-828-0565
Mailing Address - Street 1:15616 EDGEWOOD DRIVE SUITE 110
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56401-4492
Mailing Address - Country:US
Mailing Address - Phone:218-828-0565
Mailing Address - Fax:218-828-0592
Practice Address - Street 1:15616 EDGEWOOD DRIVE SUITE 110
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56401-4492
Practice Address - Country:US
Practice Address - Phone:218-828-0565
Practice Address - Fax:218-828-0592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty