Provider Demographics
NPI:1659832442
Name:DR JOHNNY G FOSTER DMD PC
Entity type:Organization
Organization Name:DR JOHNNY G FOSTER DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-543-8773
Mailing Address - Street 1:412 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5207
Mailing Address - Country:US
Mailing Address - Phone:256-543-8773
Mailing Address - Fax:
Practice Address - Street 1:412 S 2ND ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5207
Practice Address - Country:US
Practice Address - Phone:256-543-8773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental