Provider Demographics
NPI:1134743081
Name:FOSTERIS, CHARLENE VERA (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:VERA
Last Name:FOSTERIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 E OAKLAND PARK BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1800
Mailing Address - Country:US
Mailing Address - Phone:646-464-3927
Mailing Address - Fax:
Practice Address - Street 1:2826 E OAKLAND PARK BLVD STE 300
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1800
Practice Address - Country:US
Practice Address - Phone:646-464-3927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN262621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice