Provider Demographics
NPI:1295931590
Name:FOSTER, CHRISTINE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:DEODATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1451 SEBASTIAN BLVD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-5166
Mailing Address - Country:US
Mailing Address - Phone:973-769-4522
Mailing Address - Fax:
Practice Address - Street 1:1451 SEBASTIAN BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-5166
Practice Address - Country:US
Practice Address - Phone:973-769-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 17863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist