=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710842042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOHEY DENTAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2025
-----------------------------------------------------
Last Update Date | 12/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 626 CLINIC RD
-----------------------------------------------------
City | HANNIBAL
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63401-3608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-221-5719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 626 CLINIC RD
-----------------------------------------------------
City | HANNIBAL
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63401-3608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-221-5719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST, OWNER
-----------------------------------------------------
Name | DR. CHELSEA FOHEY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 573-822-4568
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------