=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184999716
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT A FORTE DDS MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2012
-----------------------------------------------------
Last Update Date | 03/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5641 W MAPLE RD
-----------------------------------------------------
City | WEST BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48322-3714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-538-3020
-----------------------------------------------------
Fax | 248-538-0892
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5641 W MAPLE RD
-----------------------------------------------------
City | WEST BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48322-3714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-538-3020
-----------------------------------------------------
Fax | 248-538-0892
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT A FORTE
-----------------------------------------------------
Credential | DDS MD
-----------------------------------------------------
Telephone | 248-538-3020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | 4301048717
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------