Individual
CHRISTY JO FOGARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH, ADT
Contact information
Practice address
636 BROADWAY ST NE, MINNEAPOLIS, MN 55413-2164
(612) 746-1530
(612) 746-1531
Mailing address
636 BROADWAY ST NE, MINNEAPOLIS, MN 55413-2164
(612) 746-1530
(612) 746-1531
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
H5961
MN
125J00000X
Dental Therapist
Primary
DT02
MN
Other
Enumeration date
08/26/2011
Last updated
11/14/2017
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