Provider Demographics
NPI:1427627322
Name:FOGG, SARAH ELISABETH (RDH)
Entity type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:ELISABETH
Last Name:FOGG
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WATCHIC ROAD 19
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-6651
Mailing Address - Country:US
Mailing Address - Phone:207-232-8831
Mailing Address - Fax:
Practice Address - Street 1:75 WATCHIC ROAD 19
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6651
Practice Address - Country:US
Practice Address - Phone:207-232-8831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME4132124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2072328831OtherUNIVERSITY OF NEW ENGLAND