Individual
DR. MARK DALE FOSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
413 N 17TH AVE, WAUSAU, WI 54401-4226
(715) 842-4649
Mailing address
4302 CANVASBACK LN, WAUSAU, WI 54401-9146
(414) 581-3222
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
6740-15
WI
Other
Enumeration date
10/13/2011
Last updated
10/13/2011
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