Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 11802 | TX |
N | 1223D0001X | Dental Public Health | 11802 | TX |
NPI | 1487657011 |
---|---|
Provider Name | Dr. Carl Douglas Foster |
First Address | El Paso, TX 79901-2838 |
Second Address | El Paso, TX 79907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 05/09/2008 |