Provider Demographics
NPI:1083220503
Name:FOSTER, JAMAAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMAAL
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 NW 91ST AVE APT 15212
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6688
Mailing Address - Country:US
Mailing Address - Phone:305-924-0692
Mailing Address - Fax:
Practice Address - Street 1:2648 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9318
Practice Address - Country:US
Practice Address - Phone:772-324-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016007151223G0001X
FLDN267061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice