Theodore A Fornetti, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901017898 Issued in MI

Practice address

1115 S Hemlock St
Suite 1
Iron Mountain, MI 49801-3800

Phone

(906) 774-2776

Fax

(906) 774-6949

NPI assigned

Aug 19, 2008

Last updated

Aug 19, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219104000000",
    "number": "1083861348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 S HEMLOCK ST",
            "address_2": "SUITE 1",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498013800",
            "telephone_number": "906-774-2776",
            "fax_number": "906-774-6949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 S HEMLOCK ST",
            "address_2": "SUITE 1",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498013800",
            "telephone_number": "906-774-2776",
            "fax_number": "906-774-6949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORNETTI",
        "first_name": "THEODORE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-19",
        "last_updated": "2008-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901017898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Joseph Fornetti, DDS
• Daniel John Fornetti, DDS
• John Thomas Fornetti, DDS
• Mary Therese Fornetti, MMS PA-C
• Paul J Fornetti, D.D.S.
• Kristen Scott Forstrom, APNP, NP-C
• Paige Alyn Fortner, AGACNP-BC
• Nicole Marie Foster Holdwick, LMSW
• Emma Leigh Foster, PA-C
• Amy R Fowler, LCSW

• General Practice Dentistry in Iron Mountain, MI
• Providers in Iron Mountain, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; 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.