Provider Demographics
NPI:1104927177
Name:FORLANO, STEPHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:FORLANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 TENNENT ROAD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726
Mailing Address - Country:US
Mailing Address - Phone:732-536-2600
Mailing Address - Fax:732-536-7574
Practice Address - Street 1:821 TENNENT ROAD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726
Practice Address - Country:US
Practice Address - Phone:732-536-2600
Practice Address - Fax:732-536-7574
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI163731223G0001X
NY0402191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice