Healthcare Provider Details

I. General information

NPI: 1821219163
Provider Name (Legal Business Name): ANGELA MARIAN FORNETTI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ANGELA MARIAN DOSS

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CASE STREET NORWAY DENTAL PC
NORWAY MI
49870
US

IV. Provider business mailing address

916 TURNER ROAD
KINGSFORD MI
49802
US

V. Phone/Fax

Practice location:
  • Phone: 906-563-8010
  • Fax: 906-563-5862
Mailing address:
  • Phone: 906-779-4232
  • Fax: 906-563-5862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901019407
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: