Provider Demographics
NPI:1518487263
Name:FOSTER, KATARINA KLEMENTINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATARINA
Middle Name:KLEMENTINA
Last Name:FOSTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6582 157TH ST W APT 110B
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6057
Mailing Address - Country:US
Mailing Address - Phone:414-305-9752
Mailing Address - Fax:
Practice Address - Street 1:16138 PILOT KNOB RD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044
Practice Address - Country:US
Practice Address - Phone:952-679-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001616122300000X
MND13914122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist