Individual
DR. LISA A FOGLE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
915 N SWAN RD, TUCSON, AZ 85711-1213
(520) 881-1858
(520) 881-2713
Mailing address
915 N SWAN RD, TUCSON, AZ 85711-1213
(520) 881-1858
(520) 881-2713
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3254
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0103480
BLUE CROSS #
AZ
01
—
191092
UNITED CONCORDIA PROVIDER
AR
01
—
877350
CMDP PROVIDER #
AZ
Enumeration date
04/25/2006
Last updated
07/08/2007
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