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NPI Code Detail

MEDICARE: DR. STEPHEN P FORSYTH DMD

MEDICARE: DR. STEPHEN P FORSYTH DMD
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
11223G0001XGeneral Practice Dentistry19-17529IL
21223G0001XGeneral Practice DentistryD008268AZ
31223G0001XGeneral Practice Dentistry2901013064MI
41223G0001XGeneral Practice Dentistry1002044-15WI

General Provider Information

NPI Number : 1518961390
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN P FORSYTH DMD
Provider Business Mailing Address
First Line : 871 CLOVER LANE
Second Line :
City : MULLETT LAKE
State : MI
Zip : 49761-0081
Country : US
Telephone Number : 231-330-8901
Fax Number :
Provider Business Practice Location Address
First Line : 545 E JOHNSON ST
Second Line :
City : FOND DU LAC
State : WI
Zip : 54935-2856
Country : US
Telephone Number : 920-924-9090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 02/28/2023

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Directions to “ DR. STEPHEN P FORSYTH DMD” Practice Location

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