Provider Demographics
NPI:1366536955
Name:FOGLEMAN, HAL GLENN (DDS)
Entity type:Individual
Prefix:DR
First Name:HAL
Middle Name:GLENN
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 1:513 LAUCHWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5502
Mailing Address - Country:US
Mailing Address - Phone:910-276-3232
Mailing Address - Fax:910-276-3230
Practice Address - Street 1:513 LAUCHWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5502
Practice Address - Country:US
Practice Address - Phone:910-276-3232
Practice Address - Fax:910-276-3230
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC41931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8992803Medicaid
NC92803OtherBCBS
NC000822046OtherUNITED CONCORDIA