Provider Demographics
NPI:1144760737
Name:FORDICE, DANIEL JEFFREY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JEFFREY
Last Name:FORDICE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SILVER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-5081
Mailing Address - Country:US
Mailing Address - Phone:218-341-8545
Mailing Address - Fax:
Practice Address - Street 1:1120 BIRCH ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4418
Practice Address - Country:US
Practice Address - Phone:507-236-4276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND138761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice