Provider Demographics
NPI:1831232990
Name:FOSTER, LISA B (DMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:B
Last Name:FOSTER
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 1:5135 DIXIE HWY
Mailing Address - Street 2:STE 22
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216
Mailing Address - Country:US
Mailing Address - Phone:502-448-0070
Mailing Address - Fax:502-448-4646
Practice Address - Street 1:5135 DIXIE HWY
Practice Address - Street 2:STE 22
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216
Practice Address - Country:US
Practice Address - Phone:502-448-0070
Practice Address - Fax:502-448-4646
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY82461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice