Provider Demographics
NPI:1922170315
Name:FOGAROS, JOHN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:FOGAROS
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 1:4085 MALLORY LN
Mailing Address - Street 2:SUITE 116
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8290
Mailing Address - Country:US
Mailing Address - Phone:615-794-8976
Mailing Address - Fax:
Practice Address - Street 1:4085 MALLORY LN
Practice Address - Street 2:SUITE 116
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8290
Practice Address - Country:US
Practice Address - Phone:615-771-1999
Practice Address - Fax:615-261-0277
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN76471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice