Provider Demographics
NPI:1265059885
Name:LUKE A. FOSTER, DDS, PLLC
Entity type:Organization
Organization Name:LUKE A. FOSTER, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-924-0709
Mailing Address - Street 1:4047 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2808
Mailing Address - Country:US
Mailing Address - Phone:952-924-0709
Mailing Address - Fax:952-746-3329
Practice Address - Street 1:4047 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2808
Practice Address - Country:US
Practice Address - Phone:952-924-0709
Practice Address - Fax:952-746-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental