Provider Demographics
NPI:1760496822
Name:FOGARTY, THOMAS JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:FOGARTY
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 1:1205 MEADOW BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6380
Mailing Address - Country:US
Mailing Address - Phone:937-426-5411
Mailing Address - Fax:937-426-9765
Practice Address - Street 1:1205 MEADOW BRIDGE DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6380
Practice Address - Country:US
Practice Address - Phone:937-426-5411
Practice Address - Fax:937-426-9765
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172161223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics