Provider Demographics
NPI:1164611901
Name:FOSTER, WILLIAM A JR (LICENSED DENTURIST)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:FOSTER
Suffix:JR
Gender:M
Credentials:LICENSED DENTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1078
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-0051
Mailing Address - Country:US
Mailing Address - Phone:541-997-6054
Mailing Address - Fax:541-997-6054
Practice Address - Street 1:524 LAUREL ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9359
Practice Address - Country:US
Practice Address - Phone:541-997-6054
Practice Address - Fax:541-997-6054
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR536084122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist