Louis Formica, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

0401414852 Issued in VA

Practice address

520 N 12TH St
Richmond, VA 23298-5064

Phone

(804) 828-3368

NPI assigned

Jun 15, 2015

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 23, 2016 through Sep 23, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vcu Dental Faculty Practice, LLC

  • General Practice Dentistry
  • Richmond, VA
  • NPI 1568037471
  NPD (past)

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

{
    "created_epoch": "1434326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548633600000",
    "number": "1114308269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 N 12TH ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232985064",
            "telephone_number": "804-828-3368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N 12TH ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232985064",
            "telephone_number": "804-828-3368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMICA",
        "first_name": "LOUIS",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-15",
        "last_updated": "2019-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401414852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Forman Psychological Services LLC
• Casey Forman
• Jared Forman, SLP
• Rebekah Forman, PH.D.
• Formation PT & Performance PLLC
• Ernest A Fornaris, M.D.
• Ann S. Forrest, DO
• Leslie Page Forrest
• Rebecca Miller Forrest, M.D.
• Diane Forse

• Dentist in Richmond, VA
• Providers in Richmond, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.