Individual
DR. MICHAEL DAVID FOSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MPH
Contact information
Practice address
117 W SEVIER AVE, SUITE 220, KINGSPORT, TN 37660-3799
(423) 224-3200
Mailing address
117 W SEVIER AVE, SUITE 220, KINGSPORT, TN 37660-3799
(423) 224-3200
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
9027
KY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
9027
KY
363AS0400X
Surgical Physician Assistant
PA560
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000184655
BCBS PIN #
KY
05
—
9500101200
—
KY
01
—
970014810
RR MCARE
KY
Enumeration date
02/01/2006
Last updated
09/13/2016
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