MEDICARE: ANTHONY FORDE D.D.S. INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	30014287	OH

General Provider Information

NPI Number	:	1164515714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY FORDE D.D.S. INC.

Provider Business Mailing Address
First Line	:	6820 RIDGE ROAD
Second Line	:	SUITE 101
City	:	PARMA
State	:	OH
Zip	:	44129-5647
Country	:	US
Telephone Number	:	440-842-2203
Fax Number	:	440-842-3101

Provider Business Practice Location Address
First Line	:	6820 RIDGE ROAD
Second Line	:	SUITE 101
City	:	PARMA
State	:	OH
Zip	:	44129-5647
Country	:	US
Telephone Number	:	440-842-2203
Fax Number	:	440-842-3101

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTHONY ANDREW FORDE
Credential	:	D.D.S.
Telephone Number	:	440-842-2203

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	08/22/2020

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