Healthcare Provider Details

I. General information

NPI: 1629436266
Provider Name (Legal Business Name): HEATHER FOSTER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER GULA

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7556 TEAGUE RD
HANOVER MD
21076-1213
US

IV. Provider business mailing address

4304 KENSINGTON RD
BALTIMORE MD
21229-4704
US

V. Phone/Fax

Practice location:
  • Phone: 410-799-9991
  • Fax:
Mailing address:
  • Phone: 301-606-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16239
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: