Provider Demographics
NPI:1487603734
Name:FOSS, TINA LOUISE (DDS)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:LOUISE
Last Name:FOSS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 N GALLOWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-7535
Mailing Address - Country:US
Mailing Address - Phone:972-686-6477
Mailing Address - Fax:972-613-7504
Practice Address - Street 1:5115 N GALLOWAY AVE
Practice Address - Street 2:301
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-7526
Practice Address - Country:US
Practice Address - Phone:972-686-6477
Practice Address - Fax:972-613-7504
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX182241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice