MEDICARE: SKYLAR FOGERTY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8197	OK

General Provider Information

NPI Number	:	1730018615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SKYLAR FOGERTY DDS

Provider Business Mailing Address
First Line	:	637 NE 106TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-4501
Country	:	US
Telephone Number	:	918-645-8221
Fax Number	:

Provider Business Practice Location Address
First Line	:	6301 NW 23RD ST
Second Line	:
City	:	BETHANY
State	:	OK
Zip	:	73008-5931
Country	:	US
Telephone Number	:	405-495-2402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2026
Last Update Date	:	05/16/2026

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Directions to “ SKYLAR FOGERTY DDS” Practice Location

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