Healthcare Provider Details

I. General information

NPI: 1619910858
Provider Name (Legal Business Name): JOHN J FOSTER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 OHLINGER RD UNIT 2
BABSON PARK FL
33827
US

IV. Provider business mailing address

900 OHLINGER RD UNIT 2
BABSON PARK FL
33827
US

V. Phone/Fax

Practice location:
  • Phone: 863-232-2392
  • Fax:
Mailing address:
  • Phone: 863-232-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN13588
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: