Provider Demographics
NPI:1861546889
Name:FOGLEMAN, RANDY LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:LEE
Last Name:FOGLEMAN
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 1:27 SANDY LANE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1320
Mailing Address - Country:US
Mailing Address - Phone:717-242-2731
Mailing Address - Fax:
Practice Address - Street 1:27 SANDY LANE
Practice Address - Street 2:SUITE 206
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1320
Practice Address - Country:US
Practice Address - Phone:717-242-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027079L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice