MEDICARE: MRS. KIA MICHELLE FOSTER RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	6119	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0	OTHER	MD	0

General Provider Information

NPI Number	:	1023744224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIA MICHELLE FOSTER RDH

Provider Business Mailing Address
First Line	:	3505 ETON DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-6800
Country	:	US
Telephone Number	:	410-212-5738
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 ETON DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-6800
Country	:	US
Telephone Number	:	410-212-5738
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	07/29/2022

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