Provider Demographics
NPI:1255525408
Name:FORNS, ALFREDO R
Entity type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:R
Last Name:FORNS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 ALMERIA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6009
Mailing Address - Country:US
Mailing Address - Phone:305-442-8481
Mailing Address - Fax:305-442-4029
Practice Address - Street 1:124 ALMERIA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6009
Practice Address - Country:US
Practice Address - Phone:305-442-8481
Practice Address - Fax:305-442-4029
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice