Provider Demographics
NPI:1275965568
Name:COLIN FORDE DDS PC
Entity Type:Organization
Organization Name:COLIN FORDE DDS PC
Other - Org Name:FAMILY & COSMETIC DENTAL DESIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FORDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-883-3722
Mailing Address - Street 1:7520 MONTGOMERY BLVD NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1521
Mailing Address - Country:US
Mailing Address - Phone:505-883-3722
Mailing Address - Fax:505-884-1479
Practice Address - Street 1:7520 MONTGOMERY BLVD NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1521
Practice Address - Country:US
Practice Address - Phone:505-883-3722
Practice Address - Fax:505-884-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD35831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty