Provider Demographics
NPI:1679698922
Name:FORTI, LARRY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:M
Last Name:FORTI
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 1:1189 SMITHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-2517
Mailing Address - Country:US
Mailing Address - Phone:401-728-6350
Mailing Address - Fax:401-728-3917
Practice Address - Street 1:1189 SMITHFIELD AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-2517
Practice Address - Country:US
Practice Address - Phone:401-728-6350
Practice Address - Fax:401-728-3917
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILF21681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice