Provider Demographics
NPI:1255639035
Name:FOSTER STREET DENTAL, LLC
Entity type:Organization
Organization Name:FOSTER STREET DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BIPLAB
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:MALO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-944-4197
Mailing Address - Street 1:8 ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4122
Mailing Address - Country:US
Mailing Address - Phone:978-944-4197
Mailing Address - Fax:
Practice Address - Street 1:80 FOSTER ST
Practice Address - Street 2:UNIT 104
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5953
Practice Address - Country:US
Practice Address - Phone:978-944-4197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty