Provider Demographics
NPI:1487657011
Name:FOSTER, CARL DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:DOUGLAS
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 1:222 S. CAMPBELL ST.
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-2838
Mailing Address - Country:US
Mailing Address - Phone:915-543-3580
Mailing Address - Fax:915-543-3510
Practice Address - Street 1:9314 JUANCITIDO LANE
Practice Address - Street 2:YSLETA DEL SUR PUEBLO COMMUNITY HEALTH CENTER
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907
Practice Address - Country:US
Practice Address - Phone:915-858-1076
Practice Address - Fax:915-858-2367
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118021223D0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health