Provider Demographics
NPI:1780745471
Name:GREEN HILLS FAMILY & COSMETIC DENTISTRY, P.C.
Entity type:Organization
Organization Name:GREEN HILLS FAMILY & COSMETIC DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARI
Authorized Official - Middle Name:REUBEN
Authorized Official - Last Name:FORGOSH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-395-0980
Mailing Address - Street 1:1150 GLENLIVET DR
Mailing Address - Street 2:SUITE C-38
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-3112
Mailing Address - Country:US
Mailing Address - Phone:610-395-0980
Mailing Address - Fax:484-223-1933
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031179L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty