Provider Demographics
NPI:1033663489
Name:FOUGHT, SHARON A (RDH, EPDH)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:FOUGHT
Suffix:
Gender:F
Credentials:RDH, EPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 W LOOKOUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-7596
Mailing Address - Country:US
Mailing Address - Phone:713-366-9663
Mailing Address - Fax:
Practice Address - Street 1:645 W LOOKOUT RIDGE DR
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-7596
Practice Address - Country:US
Practice Address - Phone:713-366-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-14
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7273124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA12Medicaid