MEDICARE: DR. MICHAEL DAVID FOSTER DMD, MPH

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	363AS0400X	Surgical Physician Assistant	PA560	KY
2	1223P0106X	Oral and Maxillofacial Pathology Dentistry	9027	KY
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	9027	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000184655	OTHER	KY	BCBS PIN #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	970014810	OTHER	KY	RR MCARE

General Provider Information

NPI Number	:	1962474304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DAVID FOSTER DMD, MPH

Provider Business Mailing Address
First Line	:	117 W SEVIER AVE
Second Line	:	SUITE 220
City	:	KINGSPORT
State	:	TN
Zip	:	37660-3799
Country	:	US
Telephone Number	:	423-224-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 W SEVIER AVE
Second Line	:	SUITE 220
City	:	KINGSPORT
State	:	TN
Zip	:	37660-3799
Country	:	US
Telephone Number	:	423-224-3200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	09/13/2016

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