Provider Demographics
NPI:1962776237
Name:FORNEY, RYAN DAVIS (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DAVIS
Last Name:FORNEY
Suffix:
Gender:
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 MONTVALE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3644
Mailing Address - Country:US
Mailing Address - Phone:781-438-7206
Mailing Address - Fax:
Practice Address - Street 1:88 MONTVALE AVE STE 5
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3644
Practice Address - Country:US
Practice Address - Phone:781-438-7206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOMS119204E00000X, 1223S0112X
MADN100005571223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery