Provider Demographics
NPI:1750436507
Name:DAVID L FORTHOFER DDS INC
Entity type:Organization
Organization Name:DAVID L FORTHOFER DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FORTHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-327-0700
Mailing Address - Street 1:35590 CENTER RIDGE ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-3057
Mailing Address - Country:US
Mailing Address - Phone:440-327-0700
Mailing Address - Fax:440-327-0237
Practice Address - Street 1:35590 CENTER RIDGE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-3057
Practice Address - Country:US
Practice Address - Phone:440-327-0700
Practice Address - Fax:440-327-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300148321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty