Provider Demographics
NPI:1982877254
Name:CYNTHIA FOSTER DDS PC
Entity Type:Organization
Organization Name:CYNTHIA FOSTER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-905-5490
Mailing Address - Street 1:23077 GREENFIELD RD STE 290
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3745
Mailing Address - Country:US
Mailing Address - Phone:248-905-5490
Mailing Address - Fax:248-905-5439
Practice Address - Street 1:23077 GREENFIELD RD STE 290
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3745
Practice Address - Country:US
Practice Address - Phone:248-905-5490
Practice Address - Fax:248-905-5439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010152341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4188738Medicaid