Provider Demographics
NPI:1346372851
Name:FORNARIS, JORGE L (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:L
Last Name:FORNARIS
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 1:401 CORAL WAY STE 211
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4924
Mailing Address - Country:US
Mailing Address - Phone:305-441-5359
Mailing Address - Fax:305-441-5360
Practice Address - Street 1:401 CORAL WAY STE 211
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4924
Practice Address - Country:US
Practice Address - Phone:305-441-5359
Practice Address - Fax:305-441-5360
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 165471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice