Provider Demographics
NPI:1861532269
Name:FOSTER, ROBERT A JR (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:FOSTER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 JOHNSON FERRY PL
Mailing Address - Street 2:SUITE C-10
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2048
Mailing Address - Country:US
Mailing Address - Phone:770-971-5119
Mailing Address - Fax:770-565-6808
Practice Address - Street 1:1230 JOHNSON FERRY RD
Practice Address - Street 2:SUITE C-10
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2048
Practice Address - Country:US
Practice Address - Phone:770-971-5119
Practice Address - Fax:770-565-6808
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice