Provider Demographics
NPI:1194938399
Name:FOGARTY, TODD M (DDS)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:M
Last Name:FOGARTY
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 1:2918 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5772
Mailing Address - Country:US
Mailing Address - Phone:719-593-1177
Mailing Address - Fax:719-531-0043
Practice Address - Street 1:2918 AUSTIN BLUFFS PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5772
Practice Address - Country:US
Practice Address - Phone:719-593-1177
Practice Address - Fax:719-531-0043
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO80421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice