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General NPI Number Information
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NPI Number | 1811041239
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Entity Type | Organization
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Legal Business Name | TED A FORNETTI DDS PC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1115 SOUTH HEMLOCK SUITE 1
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801
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Country | US
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Telephone | 906-774-4444
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Fax | 906-774-6949
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Provider Business Mailing Address
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Address Line | 1115 SOUTH HEMLOCK SUITE 1
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801
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Country | US
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Telephone | 906-774-4444
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Fax | 906-774-6949
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Authorized Official
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Title or Position | DENTIST
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Name | TED A FORNETTI
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Credential | DDS
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Telephone | 906-774-4444
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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 | 2901017898
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10422
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901019408
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License Number State | MI
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