Provider Demographics
NPI:1477608008
Name:FOSTER, MARK B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:B
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 1:856 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-2229
Mailing Address - Country:US
Mailing Address - Phone:815-838-1998
Mailing Address - Fax:815-838-4263
Practice Address - Street 1:856 N STATE ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-2229
Practice Address - Country:US
Practice Address - Phone:815-838-1998
Practice Address - Fax:815-838-4263
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice