Provider Demographics
NPI:1821219163
Name:FORNETTI, ANGELA MARIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIAN
Last Name:FORNETTI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:MARIAN
Other - Last Name:DOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:916 TURNER ROAD
Mailing Address - Street 2:
Mailing Address - City:KINGSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49802
Mailing Address - Country:US
Mailing Address - Phone:906-779-4232
Mailing Address - Fax:906-563-5862
Practice Address - Street 1:800 S CASE STREET
Practice Address - Street 2:NORWAY DENTAL PC
Practice Address - City:NORWAY
Practice Address - State:MI
Practice Address - Zip Code:49870
Practice Address - Country:US
Practice Address - Phone:906-563-8010
Practice Address - Fax:906-563-5862
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019407122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist