Provider Demographics
NPI:1639261340
Name:FOSTER, BEVERLY MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:MARIE
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 1:4800 PAYNE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-2443
Mailing Address - Country:US
Mailing Address - Phone:216-231-7700
Mailing Address - Fax:216-231-3828
Practice Address - Street 1:1468 EAST 55TH STREET
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-1307
Practice Address - Country:US
Practice Address - Phone:216-881-2000
Practice Address - Fax:216-231-3828
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17077122300000X
OH30.025571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0314965Medicaid