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General NPI Number Information
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NPI Number | 1528551801
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Entity Type | Organization
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Legal Business Name | P. JENNY FOSTER, DDS PLLC
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 06/11/2018
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Provider Practice Location Address
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Address Line | 30940 STAGECOACH BLVD # E250
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City | EVERGREEN
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State | CO
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Zip | 80439-7984
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Country | US
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Telephone | 303-674-6777
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Fax |
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Provider Business Mailing Address
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Address Line | 30940 STAGECOACH BLVD # E250
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City | EVERGREEN
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State | CO
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Zip | 80439-7984
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Country | US
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Telephone | 303-674-6777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICIA JENNY FOSTER
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Credential | DDS
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Telephone | 303-674-6777
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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 | 10506
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License Number State | CO
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