Provider Demographics
NPI:1760642201
Name:FOSTER JR, CHARLES L, DDS INC
Entity Type:Organization
Organization Name:FOSTER JR, CHARLES L, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LIONEL
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:248-635-6449
Mailing Address - Street 1:243 E MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1846
Mailing Address - Country:US
Mailing Address - Phone:909-634-8640
Mailing Address - Fax:909-634-8681
Practice Address - Street 1:243 E MISSION BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1846
Practice Address - Country:US
Practice Address - Phone:909-634-8640
Practice Address - Fax:909-634-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty