MEDICARE: FOSTER FAMILY DENTISTRY

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	1223G0001X	General Practice Dentistry	5603	OK

General Provider Information

NPI Number	:	1073507679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOSTER FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	6227 N MERIDIAN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1249
Country	:	US
Telephone Number	:	405-722-9400
Fax Number	:	405-722-9404

Provider Business Practice Location Address
First Line	:	6227 N MERIDIAN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1249
Country	:	US
Telephone Number	:	405-722-9400
Fax Number	:	405-722-9404

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER GRANT FOSTER
Credential	:	DDS
Telephone Number	:	405-722-9400

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	08/22/2020

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Directions to “FOSTER FAMILY DENTISTRY ” Practice Location

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