Provider Demographics
NPI:1215006390
Name:FOSTER, MICHAEL ERIC (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ERIC
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 1:65 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4629
Mailing Address - Country:US
Mailing Address - Phone:678-407-3919
Mailing Address - Fax:678-407-3918
Practice Address - Street 1:65 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-4629
Practice Address - Country:US
Practice Address - Phone:678-407-3919
Practice Address - Fax:678-407-3918
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist