Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2005012308 | MO |
NPI | 1336279470 |
---|---|
Provider Name | Dr. Avoyn Forga |
First Address | Anderson, MO 64831-1136 |
Second Address | Anderson, MO 64831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 09/07/2007 |