Provider Demographics
NPI:1124554142
Name:FOSTER ORTHODONTICS, PA
Entity Type:Organization
Organization Name:FOSTER ORTHODONTICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-410-1340
Mailing Address - Street 1:1055 RIBAUT ROAD BUILDING 20 STE A
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-6187
Mailing Address - Country:US
Mailing Address - Phone:843-524-6363
Mailing Address - Fax:843-522-9735
Practice Address - Street 1:1055 RIBAUT ROAD BUILDING 20 STE A
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5423
Practice Address - Country:US
Practice Address - Phone:843-524-6363
Practice Address - Fax:843-522-9735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty