Individual
MARK GARY FOHEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
101 FRANKLIN, MONONA, IA 52159
(563) 539-4651
(563) 539-4653
Mailing address
PO BOX 965, MONONA, IA 52159
(563) 539-4651
(563) 539-4653
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7066
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0031633
—
IA
01
—
1031633
MEDICAID FOR WAUKON
IA
Enumeration date
09/07/2006
Last updated
07/09/2007
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