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General NPI Number Information
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NPI Number | 1497726590
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Entity Type | Individual
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Provider Name | EDMISE FORESTAL DDS
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Gender | Female
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Dates
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Enumeration Date | 01/28/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1839 CENTRAL AVE
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City | ALBANY
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State | NY
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Zip | 12205-4748
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Country | US
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Telephone | 518-464-0402
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Fax | 518-464-0409
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Provider Business Mailing Address
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Address Line | 415 N GRAND AVE
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City | PUEBLO
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State | CO
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Zip | 81003-3111
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Country | US
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Telephone | 719-583-1800
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Fax | 719-583-1801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 052278
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License Number State | NY
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