Provider Demographics
NPI:1346397718
Name:FORDE, ANDREW ALLAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ALLAN
Last Name:FORDE
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 1:30915 LORAIN RD
Mailing Address - Street 2:#200
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-4722
Mailing Address - Country:US
Mailing Address - Phone:440-734-0041
Mailing Address - Fax:440-734-9690
Practice Address - Street 1:30915 LORAIN RD
Practice Address - Street 2:#200
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-4722
Practice Address - Country:US
Practice Address - Phone:440-734-0041
Practice Address - Fax:440-734-9690
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice