MEDICARE: DR. STEPHEN ALAN FOSTER D.D.S.

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	122300000X	Dentist	DS 4633	TN

General Provider Information

NPI Number	:	1508877465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN ALAN FOSTER D.D.S.

Provider Business Mailing Address
First Line	:	11316 LEBANON RD
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-5504
Country	:	US
Telephone Number	:	615-754-2295
Fax Number	:	615-758-6565

Provider Business Practice Location Address
First Line	:	11316 LEBANON RD
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-5504
Country	:	US
Telephone Number	:	615-754-2295
Fax Number	:	615-758-6565

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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