MEDICARE: DR. DAVID LEE FORTHOFER DDS

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	1223G0001X	General Practice Dentistry	30014832	OH

General Provider Information

NPI Number	:	1942354493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LEE FORTHOFER DDS

Provider Business Mailing Address
First Line	:	35590 CENTER RIDGE ROAD
Second Line	:	SUITE 102
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-3057
Country	:	US
Telephone Number	:	440-327-0700
Fax Number	:	440-327-0237

Provider Business Practice Location Address
First Line	:	35590 CENTER RIDGE ROAD
Second Line	:	SUITE 102
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-3057
Country	:	US
Telephone Number	:	440-327-0700
Fax Number	:	440-327-0237

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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