Provider Demographics
NPI:1568520328
Name:FOSMAN, CODRUTA IULIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CODRUTA
Middle Name:IULIANA
Last Name:FOSMAN
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 1:1120 TIMBERS DR
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1759
Mailing Address - Country:US
Mailing Address - Phone:952-807-7176
Mailing Address - Fax:952-486-8131
Practice Address - Street 1:205 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1434
Practice Address - Country:US
Practice Address - Phone:218-732-4436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12031122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNMA#458948300OtherMINNESOTA MEDICAL ASSIST.