Provider Demographics
NPI:1235213646
Name:FOGO, JAMES M SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:FOGO
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:8212 MILL RACE DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6844
Mailing Address - Country:US
Mailing Address - Phone:423-238-9513
Mailing Address - Fax:423-238-3785
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
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Provider Licenses
StateLicense IDTaxonomies
TN34481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice