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General NPI Number Information
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NPI Number | 1023235710
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Entity Type | Organization
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Legal Business Name | G.R. FOSTER III D.M.D. P.C.
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 153 DECATUR RD
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City | MCDONOUGH
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State | GA
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Zip | 30253-2025
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Country | US
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Telephone | 770-957-2923
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Fax | 770-957-2924
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Provider Business Mailing Address
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Address Line | 153 DECATUR RD
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City | MCDONOUGH
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State | GA
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Zip | 30253-2025
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Country | US
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Telephone | 770-957-2923
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Fax | 770-957-2924
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GURDON R. FOSTER III
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Credential | D.M.D.
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Telephone | 770-957-2923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 8268
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License Number State | GA
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