Healthcare Provider Details

I. General information

NPI: 1942460100
Provider Name (Legal Business Name): JEFFREY STEPHEN FORGOSH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 PLEASANT STREET
CONCORD NH
03301
US

IV. Provider business mailing address

280 PLEASANT STREET
CONCORD NH
03301
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 Number1405
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: