Max Forni, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

15652 Issued in FL

Practice address

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

Phone

(863) 676-6021

Fax

(863) 679-6406

NPI assigned

Oct 3, 2006

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

Enrolled in FL

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.

Enrollment records 1

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.

• Max Forni DMD P.a.

  • General Practice Dentistry
  • Lake Wales, FL
  • NPI 1053540153
  NPD (past) Authorized official

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356435473",
    "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": {
        "last_name": "FORNI",
        "first_name": "MAX",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "15652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Florida Hospital Physician Group Inc
• Florida Medical Specialists, LLC
• Florida Professional Chiropractic
• Flos Passionate Company Home Health Care LLC
• Sarah E Fonseca-Martinez, RBT
• Donald Sanford Franklin, MD
• La-Fern Fray, PTA
• Marilyn D Frontera Vargas, D.C
• Letitia T Fry, LDO
• Briana Fullington, LMHC

• General Practice Dentistry in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.