Jeff Fordice DDS LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D9297 Issued in MN

Legal business name

JEFF FORDICE DDS LLC

Practice address

1120 Birch St
Fairmont, MN 56031-4418

Phone

(507) 238-4276

NPI assigned

Jan 3, 2012

Organization subpart

No

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

Authorized official

Name

Jeff Fordice, DDS

Title

Owner

Phone

(507) 238-4276

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

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

• Jeffrey Howard Fordice, DDS

  • General Practice Dentistry
  • Fairmont, MN
  • NPI 1083679732
  NPD (past)

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

{
    "created_epoch": "1325548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325548800000",
    "number": "1417227828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 BIRCH ST",
            "city": "FAIRMONT",
            "state": "MN",
            "postal_code": "560314418",
            "telephone_number": "507-238-4276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 BIRCH ST",
            "city": "FAIRMONT",
            "state": "MN",
            "postal_code": "560314418",
            "telephone_number": "507-238-4276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFF FORDICE DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-03",
        "last_updated": "2012-01-03",
        "status": "A",
        "authorized_official_last_name": "FORDICE",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-238-4276",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D9297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Fairmont, MN
• Providers in Fairmont, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.