MEDICARE: LUKE EDWARD FOGARTY DMD

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	DN31727	FL

General Provider Information

NPI Number	:	1992494686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE EDWARD FOGARTY DMD

Provider Business Mailing Address
First Line	:	3411 JOHNSON ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-5420
Country	:	US
Telephone Number	:	954-820-5304
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 JOHNSON ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-5420
Country	:	US
Telephone Number	:	954-820-5304
Fax Number	:

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

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	06/22/2026

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