Provider Demographics
NPI:1073507679
Name:FOSTER FAMILY DENTISTRY
Entity Type:Organization
Organization Name:FOSTER FAMILY DENTISTRY
Other - Org Name:CHRISTOPHER G FOSTER DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-722-9400
Mailing Address - Street 1:6227 N MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1249
Mailing Address - Country:US
Mailing Address - Phone:405-722-9400
Mailing Address - Fax:405-722-9404
Practice Address - Street 1:6227 N MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1249
Practice Address - Country:US
Practice Address - Phone:405-722-9400
Practice Address - Fax:405-722-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty