Provider Demographics
NPI:1790916476
Name:FOGLEMAN, THRESSA K (RDH)
Entity Type:Individual
Prefix:MRS
First Name:THRESSA
Middle Name:K
Last Name:FOGLEMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:THRESSA
Other - Middle Name:KARINE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:2355 AMERICAN LEGION BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-3145
Mailing Address - Country:US
Mailing Address - Phone:208-587-7949
Mailing Address - Fax:208-587-7949
Practice Address - Street 1:2355 AMERICAN LEGION BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-3145
Practice Address - Country:US
Practice Address - Phone:208-587-7949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDDH-2168124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist