Provider Demographics
NPI:1699870741
Name:FOSTER, MICHAEL JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:FOSTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1712
Mailing Address - Country:US
Mailing Address - Phone:415-461-5933
Mailing Address - Fax:415-461-4897
Practice Address - Street 1:599 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1712
Practice Address - Country:US
Practice Address - Phone:415-461-5933
Practice Address - Fax:415-461-4897
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA215711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice