Provider Demographics
NPI:1215096631
Name:FOSTER, JOIE (RDH,BS)
Entity type:Individual
Prefix:MS
First Name:JOIE
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:RDH,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 BLACK DUCK AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-9286
Mailing Address - Country:US
Mailing Address - Phone:970-587-0790
Mailing Address - Fax:
Practice Address - Street 1:2130 BLACK DUCK AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-9286
Practice Address - Country:US
Practice Address - Phone:970-587-0790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO903875124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43326030Medicaid