Provider Demographics
NPI:1376353250
Name:FOTHERGILL, NAOMI (RDH)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:FOTHERGILL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 BROENING HWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5525
Mailing Address - Country:US
Mailing Address - Phone:773-629-0343
Mailing Address - Fax:
Practice Address - Street 1:9256 BENDIX RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1843
Practice Address - Country:US
Practice Address - Phone:410-541-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8455124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist