Provider Demographics
NPI:1811092620
Name:FOSTER, ROY DAMIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:DAMIAN
Last Name:FOSTER
Suffix:
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 1:1019 FLAGSTONE DRIVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130
Mailing Address - Country:US
Mailing Address - Phone:812-288-2349
Mailing Address - Fax:
Practice Address - Street 1:5135 DIXIE HWY
Practice Address - Street 2:SUITE 22
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1771
Practice Address - Country:US
Practice Address - Phone:502-448-0070
Practice Address - Fax:502-448-4646
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY82921223G0001X
IN12010919A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice