Provider Demographics
NPI:1942354493
Name:FORTHOFER, DAVID LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:FORTHOFER
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 1:35590 CENTER RIDGE ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-3057
Mailing Address - Country:US
Mailing Address - Phone:440-327-0700
Mailing Address - Fax:440-327-0237
Practice Address - Street 1:35590 CENTER RIDGE ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-3057
Practice Address - Country:US
Practice Address - Phone:440-327-0700
Practice Address - Fax:440-327-0237
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300148321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice