Provider Demographics
NPI:1932213683
Name:FOSTER, MICHAEL DAVID
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:FOSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 W ROBINHOOD DR
Mailing Address - Street 2:C-7
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5515
Mailing Address - Country:US
Mailing Address - Phone:209-478-8221
Mailing Address - Fax:
Practice Address - Street 1:1341 W ROBINHOOD DR
Practice Address - Street 2:C-7
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5515
Practice Address - Country:US
Practice Address - Phone:209-478-8221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist