Healthcare Provider Details

I. General information

NPI: 1821146382
Provider Name (Legal Business Name): SAMUEL C FOSTER DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 WILLOW ST
SOUTH HAMILTON MA
01982-2227
US

IV. Provider business mailing address

78 WILLOW ST
SOUTH HAMILTON MA
01982-2227
US

V. Phone/Fax

Practice location:
  • Phone: 978-468-5048
  • Fax: 978-468-4613
Mailing address:
  • Phone: 978-468-5048
  • Fax: 978-468-4613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11283
License Number StateMA

VIII. Authorized Official

Name: SAMUEL C FOSTER
Title or Position: PRESIDENT
Credential: DMD
Phone: 978-468-5048