Provider Demographics
NPI:1083798409
Name:FOGO, LARRY E SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:E
Last Name:FOGO
Suffix:SR
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 1:4736 SUSSEX LN
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1137
Mailing Address - Country:US
Mailing Address - Phone:423-894-0954
Mailing Address - Fax:
Practice Address - Street 1:4933 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3902
Practice Address - Country:US
Practice Address - Phone:423-899-1948
Practice Address - Fax:423-855-5905
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice