Provider Demographics
NPI:1689848194
Name:FORMAN, ERROL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERROL
Middle Name:
Last Name:FORMAN
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 1:6690 ROSWELL RD NE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3161
Mailing Address - Country:US
Mailing Address - Phone:404-256-6474
Mailing Address - Fax:404-303-7395
Practice Address - Street 1:6690 ROSWELL RD NE
Practice Address - Street 2:SUITE 530
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3161
Practice Address - Country:US
Practice Address - Phone:404-256-6474
Practice Address - Fax:404-303-7395
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0111921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice