Provider Demographics
NPI:1023192499
Name:STEVEN S. FORMAN D.D.S., P.C.
Entity type:Organization
Organization Name:STEVEN S. FORMAN D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:FORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-356-1777
Mailing Address - Street 1:65 MOUNTAIN BLVD EXT
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-2632
Mailing Address - Country:US
Mailing Address - Phone:732-356-1777
Mailing Address - Fax:732-302-3082
Practice Address - Street 1:65 MOUNTAIN BLVD EXT
Practice Address - Street 2:SUITE 204
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2632
Practice Address - Country:US
Practice Address - Phone:732-356-1777
Practice Address - Fax:732-302-3082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ011442261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental