Provider Demographics
NPI:1205193372
Name:FORLOINE, AMY (DDS, MS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FORLOINE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N DIXIE HWY
Mailing Address - Street 2:P.O. BOX 24
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-7749
Mailing Address - Country:US
Mailing Address - Phone:419-738-6944
Mailing Address - Fax:
Practice Address - Street 1:715 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-7749
Practice Address - Country:US
Practice Address - Phone:419-738-6944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300215011223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics