Provider Demographics
NPI:1083277735
Name:FOREFRONT DERMATOLOGY, S.C.
Entity Type:Organization
Organization Name:FOREFRONT DERMATOLOGY, S.C.
Other - Org Name:LAING DERMATOLOGY, A FOREFRONT DERMATOLOGY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR, PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-663-9022
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:6807 KNIGHTDALE BLVD STE C
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6563
Practice Address - Country:US
Practice Address - Phone:919-217-5510
Practice Address - Fax:919-217-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty