MEDICARE: BENJAMIN W. FOSTER, JR. D.D.S. INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3955	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1912177544	OTHER	VA	DR FOSTER NPI

General Provider Information

NPI Number	:	1023122264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENJAMIN W. FOSTER, JR. D.D.S. INC.

Provider Business Mailing Address
First Line	:	3800 POPLAR HILL RD STE F
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5522
Country	:	US
Telephone Number	:	757-484-8564
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 POPLAR HILL RD STE F
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5522
Country	:	US
Telephone Number	:	757-484-8564
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/DENTIST
Name	:	BENJAMIN W FOSTER JR.
Credential	:	D.D.S.
Telephone Number	:	757-484-8564

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	10/31/2011

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