NPIMap

Organization Active NPI

Max Forni DMD P.a.

  • General Practice Dentistry
  • Lake Wales, FL
National Provider Identifier
1053540153
Registry record updated Jul 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN15652 Issued in FL
Legal business name
MAX FORNI DMD P.A.
Practice address
701 State Road 60 E
Lake Wales, FL 33853-4240
Phone
(863) 676-6021
Fax
(863) 679-6406
NPI assigned
Jul 9, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Max Forni, DMDNPI 1356435473
Title
President
Phone
(863) 676-6021

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DN15652 FL Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DN18156 FL

Addresses

Primary practice location

701 State Road 60 E
Lake Wales, FL 33853-4240

Mailing address

701 State Road 60 E
Lake Wales, FL 33853-4240
Phone (863) 676-6021

National Provider Directory

National Provider Directory

Locations

701 State Road 60 E
Lake Wales, FL 33853
Phone (863) 563-3663

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247097600000",
    "number": "1053540153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 STATE ROAD 60 E",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534240",
            "telephone_number": "863-676-6021",
            "fax_number": "863-679-6406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 STATE ROAD 60 E",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534240",
            "telephone_number": "863-676-6021",
            "fax_number": "863-679-6406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAX FORNI DMD P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-09",
        "last_updated": "2009-07-09",
        "status": "A",
        "authorized_official_last_name": "FORNI",
        "authorized_official_first_name": "MAX",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "863-676-6021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN15652",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN18156",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Wales, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.