Organization Name: | G.R. FOSTER III D.M.D. P.C. |
NPI Number: | 1023235710 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GURDON R. FOSTER (PRESIDENT) |
Mailing Address: | 153 Decatur Rd Mcdonough |
State: | GA US |
Postal Code: | 302532025 |
Phone Number: | 7709572923 |
Fax Number: | 7709572924 |
NPI Enumeration Date: | 04/20/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 8268 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |