Provider Demographics
NPI:1154524692
Name:FOSTER JR, CHARLES L, DDS INC
Entity type:Organization
Organization Name:FOSTER JR, CHARLES L, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:323-773-1664
Mailing Address - Street 1:7705 ATLANTIC AVE
Mailing Address - Street 2:#B
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-5085
Mailing Address - Country:US
Mailing Address - Phone:323-773-1664
Mailing Address - Fax:323-773-7365
Practice Address - Street 1:7705 ATLANTIC AVE
Practice Address - Street 2:B
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-5085
Practice Address - Country:US
Practice Address - Phone:323-773-1664
Practice Address - Fax:323-773-7365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG93677-031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty