Provider Demographics
NPI:1972720654
Name:FORETICH, ERIC A (DDS, MA)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:A
Last Name:FORETICH
Suffix:
Gender:M
Credentials:DDS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10440 NEW ASCOT DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-3421
Mailing Address - Country:US
Mailing Address - Phone:703-759-5530
Mailing Address - Fax:
Practice Address - Street 1:1515 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4451
Practice Address - Country:US
Practice Address - Phone:703-893-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA38441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery