Healthcare Provider Details

I. General information

NPI: 1689752537
Provider Name (Legal Business Name): DR ERIC J FOSTER DDS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 36TH STREET SW
GRAND RAPIDS MI
49509
US

IV. Provider business mailing address

630 36TH STREET SW
GRAND RAPIDS MI
49509
US

V. Phone/Fax

Practice location:
  • Phone: 616-538-4330
  • Fax: 616-538-5353
Mailing address:
  • Phone: 616-538-4330
  • Fax: 616-538-5353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901018395
License Number StateMI

VIII. Authorized Official

Name: DR. ERIC JOHN FOSTER
Title or Position: DENTIST
Credential: DDS
Phone: 616-538-4330