Healthcare Provider Details

I. General information

NPI: 1154249241
Provider Name (Legal Business Name): CAITLYN FOGGO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1476 W GOVERNMENT ST UNIT A
BRANDON MS
39042-3051
US

IV. Provider business mailing address

425 TURTLE LN
BRANDON MS
39047-5078
US

V. Phone/Fax

Practice location:
  • Phone: 601-724-4500
  • Fax:
Mailing address:
  • Phone: 601-334-1967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112770
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: