Healthcare Provider Details

I. General information

NPI: 1144206798
Provider Name (Legal Business Name): MICHAEL JOHN FORAN D.M.D., OMFS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19910 N COVE RD
CORNELIUS NC
28031-6447
US

IV. Provider business mailing address

2522 GREEN POINT LN
DENVER NC
28037-9429
US

V. Phone/Fax

Practice location:
  • Phone: 704-892-1198
  • Fax:
Mailing address:
  • Phone: 301-758-2680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS03578
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN014565
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number09973
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: