MEDICARE: DR. CODRUTA IULIANA FOSMAN DDS

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	D12031	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA#458948300	OTHER	MN	MINNESOTA MEDICAL ASSIST.

General Provider Information

NPI Number	:	1568520328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CODRUTA IULIANA FOSMAN DDS

Provider Business Mailing Address
First Line	:	1120 TIMBERS DR
Second Line	:
City	:	PARK RAPIDS
State	:	MN
Zip	:	56470-1759
Country	:	US
Telephone Number	:	952-807-7176
Fax Number	:	952-486-8131

Provider Business Practice Location Address
First Line	:	205 PLEASANT AVE S
Second Line	:
City	:	PARK RAPIDS
State	:	MN
Zip	:	56470-1434
Country	:	US
Telephone Number	:	218-732-4436
Fax Number	:

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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