Provider Demographics
NPI:1841889342
Name:TARA A FOGLE, D.M.D, P.C.
Entity type:Organization
Organization Name:TARA A FOGLE, D.M.D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:FOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-461-1141
Mailing Address - Street 1:98 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1645
Mailing Address - Country:US
Mailing Address - Phone:770-461-1141
Mailing Address - Fax:770-461-1143
Practice Address - Street 1:98 N PARK DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1645
Practice Address - Country:US
Practice Address - Phone:770-461-1141
Practice Address - Fax:770-461-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty