Provider Demographics
NPI:1245249663
Name:FORMAN, TED P (DDS)
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:P
Last Name:FORMAN
Suffix:
Gender:M
Credentials:DDS
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Other - First Name:
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Mailing Address - Street 1:11700 MUKILTEO SPEEDWAY
Mailing Address - Street 2:SUITE 502
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275
Mailing Address - Country:US
Mailing Address - Phone:425-290-5573
Mailing Address - Fax:425-290-3643
Practice Address - Street 1:11700 MUKILTEO SPEEDWAY
Practice Address - Street 2:SUITE 502
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275
Practice Address - Country:US
Practice Address - Phone:425-290-5573
Practice Address - Fax:425-290-3643
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA6787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist