Provider Demographics
NPI:1912735093
Name:FOGG, JESSICA M (RDH)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
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 1:38 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-4607
Mailing Address - Country:US
Mailing Address - Phone:774-644-0500
Mailing Address - Fax:
Practice Address - Street 1:1173 WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02841-1632
Practice Address - Country:US
Practice Address - Phone:401-841-2541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH88668124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist