Provider Demographics
NPI:1114132115
Name:ROBERT A FOSTER JR DMD PC
Entity Type:Organization
Organization Name:ROBERT A FOSTER JR DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-971-5119
Mailing Address - Street 1:1230 JOHNSON FERRY PL
Mailing Address - Street 2:SUITE C-10
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2048
Mailing Address - Country:US
Mailing Address - Phone:770-971-5119
Mailing Address - Fax:770-565-6308
Practice Address - Street 1:1230 JOHNSON FERRY PL
Practice Address - Street 2:SUITE C-10
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2048
Practice Address - Country:US
Practice Address - Phone:770-971-5119
Practice Address - Fax:770-565-6308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0007966261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental