Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 30014287 | OH |
NPI | 1023127628 |
---|---|
Provider Name | Anthony Forde |
First Address | Parma, OH 44129-5646 |
Second Address | Parma, OH 44129-5646 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 01/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T-46987 | (02) | OH |