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General NPI Number Information
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NPI Number | 1124738646
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Entity Type | Organization
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Legal Business Name | FOSTER ORTHODONTICS LLC
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 1942 ATKINSON RD STE 500
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5006
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Country | US
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Telephone | 470-508-0085
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 NOURS CIR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-9115
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Country | US
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Telephone | 470-508-0085
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Fax |
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | DR. DESMOND FOSTER
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Credential | DMD, MS
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Telephone | 470-508-0085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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