Provider Demographics
NPI:1548344880
Name:FOGO AND FOGO DDS ASSOCIATED
Entity type:Organization
Organization Name:FOGO AND FOGO DDS ASSOCIATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIS
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOGO
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-899-1948
Mailing Address - Street 1:4933 BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3902
Mailing Address - Country:US
Mailing Address - Phone:423-899-1948
Mailing Address - Fax:423-855-5905
Practice Address - Street 1:4933 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3902
Practice Address - Country:US
Practice Address - Phone:423-899-1948
Practice Address - Fax:423-855-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7781223G0001X
TN34481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty