Provider Demographics
NPI:1790087674
Name:FOSTER, IREN INDJI (DDS)
Entity Type:Individual
Prefix:DR
First Name:IREN
Middle Name:INDJI
Last Name:FOSTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:IREN
Other - Middle Name:INDJI
Other - Last Name:ORFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:800 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1083
Mailing Address - Country:US
Mailing Address - Phone:716-824-5857
Mailing Address - Fax:716-824-5890
Practice Address - Street 1:800 HARLEM RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1083
Practice Address - Country:US
Practice Address - Phone:716-824-5857
Practice Address - Fax:716-824-5890
Is Sole Proprietor?:No
Enumeration Date:2010-11-26
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0555411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice