Provider Demographics
NPI:1013018621
Name:FOSQUE, FLETCHER DRUMMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:FLETCHER
Middle Name:DRUMMOND
Last Name:FOSQUE
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 1:5 FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:ONANCOCK
Mailing Address - State:VA
Mailing Address - Zip Code:23417-1303
Mailing Address - Country:US
Mailing Address - Phone:757-787-2565
Mailing Address - Fax:757-787-2354
Practice Address - Street 1:5 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:ONANCOCK
Practice Address - State:VA
Practice Address - Zip Code:23417-1303
Practice Address - Country:US
Practice Address - Phone:757-787-2565
Practice Address - Fax:757-787-2354
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010055211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007822014Medicaid
VA541282518OtherTIN