Provider Demographics
NPI:1336279470
Name:FORGA, AVOYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AVOYN
Middle Name:
Last Name:FORGA
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:PO BOX 1136
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:MO
Mailing Address - Zip Code:64831-1136
Mailing Address - Country:US
Mailing Address - Phone:417-845-2243
Mailing Address - Fax:417-845-2533
Practice Address - Street 1:508 WEST 76 HWY.
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831
Practice Address - Country:US
Practice Address - Phone:417-845-2243
Practice Address - Fax:417-845-2533
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050123081223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health