Provider Demographics
NPI:1841751252
Name:FOOTE, RICHARD (DMD, MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:FOOTE
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 BOARDWALK
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2607
Mailing Address - Country:US
Mailing Address - Phone:775-690-6350
Mailing Address - Fax:
Practice Address - Street 1:909 BOARDWALK
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2607
Practice Address - Country:US
Practice Address - Phone:775-690-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1081311223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery