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General NPI Number Information
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NPI Number | 1902919079
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Entity Type | Organization
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Legal Business Name | JEFFREY S. FORGOSH, D.MD., P.A.
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 280 PLEASANT ST
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City | CONCORD
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State | NH
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Zip | 03301-2553
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Country | US
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Telephone | 603-228-1191
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Fax | 603-228-1317
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Provider Business Mailing Address
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Address Line | 280 PLEASANT ST
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City | CONCORD
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State | NH
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Zip | 03301-2553
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Country | US
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Telephone | 603-228-1191
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Fax | 603-228-1317
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | DR. JEFFREY STEPHEN FORGOSH
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Credential | D.M.D.
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Telephone | 603-228-1191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | NH 1405
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License Number State | NH
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