Provider Demographics
NPI:1952318958
Name:GORMAN, RICHARD FORBES (DDS, MSCO,PA)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FORBES
Last Name:GORMAN
Suffix:
Gender:M
Credentials:DDS, MSCO,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-4445
Mailing Address - Country:US
Mailing Address - Phone:252-638-8155
Mailing Address - Fax:252-638-9069
Practice Address - Street 1:2409 GRACE AVE
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-4445
Practice Address - Country:US
Practice Address - Phone:252-638-8155
Practice Address - Fax:252-638-9069
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC93289OtherBCBS
NC8993289Medicaid
178-580OtherUNITED CONCORDIA