Healthcare Provider Details

I. General information

NPI: 1902919079
Provider Name (Legal Business Name): JEFFREY S. FORGOSH, D.MD., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 PLEASANT ST
CONCORD NH
03301-2553
US

IV. Provider business mailing address

280 PLEASANT ST
CONCORD NH
03301-2553
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-1191
  • Fax: 603-228-1317
Mailing address:
  • Phone: 603-228-1191
  • Fax: 603-228-1317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberNH 1405
License Number StateNH

VIII. Authorized Official

Name: DR. JEFFREY STEPHEN FORGOSH
Title or Position: OWNER/PRACTITIONER
Credential: D.M.D.
Phone: 603-228-1191