Provider Demographics
NPI:1295849354
Name:FOSTER, DONNA LOUISE (MDM)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LOUISE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 N JACKSON ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2952
Mailing Address - Country:US
Mailing Address - Phone:601-823-9872
Mailing Address - Fax:601-823-9873
Practice Address - Street 1:439 N JACKSON ST
Practice Address - Street 2:SUITE F
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2952
Practice Address - Country:US
Practice Address - Phone:601-823-9872
Practice Address - Fax:601-823-9873
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1925811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice