Provider Demographics
NPI:1942973912
Name:FOERSTER, ELAINE DANIELLE (DMD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:DANIELLE
Last Name:FOERSTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 DWIGHT RD
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1993
Mailing Address - Country:US
Mailing Address - Phone:413-567-1221
Mailing Address - Fax:
Practice Address - Street 1:123 DWIGHT RD
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1993
Practice Address - Country:US
Practice Address - Phone:413-567-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18590961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice