Provider Demographics
NPI:1518036490
Name:FOSTER, CYNTHIA (DDS)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:FOSTERSCHKOOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23077 GREENFIELD RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-905-5490
Mailing Address - Fax:248-905-5439
Practice Address - Street 1:23077 GREENFIELD RD
Practice Address - Street 2:SUITE 290
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3709
Practice Address - Country:US
Practice Address - Phone:248-905-5490
Practice Address - Fax:248-905-5439
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID01523401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4188738Medicaid
MID152340OtherLISENCE NUMBER