Provider Demographics
NPI:1710267869
Name:KEN FOSTER, DMD LLC
Entity Type:Organization
Organization Name:KEN FOSTER, DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-678-3384
Mailing Address - Street 1:683 S. MOUNTAIN BLVD SUITE#4
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-9603
Mailing Address - Country:US
Mailing Address - Phone:570-678-3383
Mailing Address - Fax:
Practice Address - Street 1:683 S. MOUNTAIN BLVD SUITE#4
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-9603
Practice Address - Country:US
Practice Address - Phone:570-678-3383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0368771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty