Provider Demographics
NPI:1164515557
Name:FOSTER, TYGER (DDS)
Entity Type:Individual
Prefix:DR
First Name:TYGER
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 1:145 SULLYS TRL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4561
Mailing Address - Country:US
Mailing Address - Phone:585-381-2190
Mailing Address - Fax:585-381-2198
Practice Address - Street 1:145 SULLYS TRL
Practice Address - Street 2:SUITE 1
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4561
Practice Address - Country:US
Practice Address - Phone:585-381-2190
Practice Address - Fax:585-381-2198
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050773-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02635096Medicaid
NY70456TFOtherEXCELLUS BC/BS