Provider Demographics
NPI:1053523548
Name:LAURA L. FOGLE, D.D.S., M.S., P.C.
Entity type:Organization
Organization Name:LAURA L. FOGLE, D.D.S., M.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:616-784-5993
Mailing Address - Street 1:890 THREE MILE RD., NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8216
Mailing Address - Country:US
Mailing Address - Phone:616-784-5993
Mailing Address - Fax:616-784-5995
Practice Address - Street 1:890 THREE MILE RD., NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8216
Practice Address - Country:US
Practice Address - Phone:616-784-5993
Practice Address - Fax:616-784-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010166821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty