Provider Demographics
NPI:1083146823
Name:FORCIOLI, LAURENT J (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURENT
Middle Name:J
Last Name:FORCIOLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LILAC LN
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2626
Mailing Address - Country:US
Mailing Address - Phone:630-627-1495
Mailing Address - Fax:
Practice Address - Street 1:14 LILAC LN
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2626
Practice Address - Country:US
Practice Address - Phone:630-627-1495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL019032402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program