Provider Demographics
NPI:1942598032
Name:FOSTER, PATRICIA JENNY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JENNY
Last Name:FOSTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:JENNY
Other - Last Name:BERTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:28532 SHADOW MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-8610
Mailing Address - Country:US
Mailing Address - Phone:303-801-7972
Mailing Address - Fax:
Practice Address - Street 1:7900 W 44TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4563
Practice Address - Country:US
Practice Address - Phone:303-422-7978
Practice Address - Fax:303-422-7979
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105061223G0001X
MO20110175341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice