Provider Demographics
NPI:1265593941
Name:FORGOSH, ARI REUBEN (DMD)
Entity type:Individual
Prefix:DR
First Name:ARI
Middle Name:REUBEN
Last Name:FORGOSH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 GLENLIVET DR
Mailing Address - Street 2:STE C38
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-3123
Mailing Address - Country:US
Mailing Address - Phone:610-395-0980
Mailing Address - Fax:
Practice Address - Street 1:1150 GLENLIVET DR
Practice Address - Street 2:SUITE C-38
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-3112
Practice Address - Country:US
Practice Address - Phone:610-395-0980
Practice Address - Fax:484-223-1933
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031179L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist