Provider Demographics
NPI:1063420990
Name:DAN FORTH DENTAL PC
Entity type:Organization
Organization Name:DAN FORTH DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:FACELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-872-3598
Mailing Address - Street 1:1671 WORCESTER ROAD
Mailing Address - Street 2:STE 401
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701
Mailing Address - Country:US
Mailing Address - Phone:508-872-3598
Mailing Address - Fax:508-872-0931
Practice Address - Street 1:1671 WORCESTER ROAD
Practice Address - Street 2:STE 401
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701
Practice Address - Country:US
Practice Address - Phone:508-872-3598
Practice Address - Fax:508-872-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA148331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA14833OtherDENTAL