| Tara A Fogle, D.m.d, P.c. | |
|
98 N Park Dr Fayetteville GA 30214-1645 | |
| (770) 461-1141 | |
| (770) 461-1143 |
| Full Name | Tara A Fogle, D.m.d, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 98 N Park Dr, Fayetteville, Georgia |
| Authorized Official Name and Position | Tara Austin Fogle (OWNER/PRESIDENT) |
| Authorized Official Contact | 7704611141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tara A Fogle, D.m.d, P.c. 98 N Park Dr Fayetteville GA 30214-1645 Ph: (770) 461-1141 | Tara A Fogle, D.m.d, P.c. 98 N Park Dr Fayetteville GA 30214-1645 Ph: (770) 461-1141 |
| NPI Number | 1841889342 |
|---|---|
| Provider Enumeration Date | 01/11/2021 |
| Last Update Date | 01/11/2021 |
| Medicare PECOS PAC ID | 4082074802 |
|---|---|
| Medicare Enrollment ID | O20230712001350 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841889342 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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