Russell L Forman, DMD, PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DN18021 Issued in MA

Legal business name

RUSSELL L FORMAN, DMD, PC

Practice address

875 Massachusetts Ave
Suite 63
Cambridge, MA 02139-3067

Phone

(617) 868-5500

NPI assigned

Sep 22, 2015

Last updated

Sep 22, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Russell Lang Forman, D.M.D.NPI 1790836120

Title

Owner

Phone

(617) 868-5500

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Russell Lang Forman, D.M.D.

  • General Practice Dentistry
  • Cambridge, MA
  • NPI 1790836120
  NPD (past) Authorized official
• Khristy Fontillas, DMD

  • General Practice Dentistry
  • Cambridge, MA
  • NPI 1871900100
  NPD (past)

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

{
    "created_epoch": "1442880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442880000000",
    "number": "1568831493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 MASSACHUSETTS AVE",
            "address_2": "SUITE 63",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393067",
            "telephone_number": "617-868-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 MASSACHUSETTS AVE",
            "address_2": "SUITE 63",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393067",
            "telephone_number": "617-868-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL L FORMAN, DMD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-22",
        "last_updated": "2015-09-22",
        "status": "A",
        "authorized_official_last_name": "FORMAN",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "LANG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-868-5500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MA",
            "license": "DN18021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura A Ruoff, M.D.
• Jacquelyn Nicole Rupp
• Kaitlin Elizabeth Ruppel, M.S., CCC-SLP
• John Thomas Rusnock, DMD
• Angelee Russ-Carbin, MSW, MPH
• Sydney Hannah Russell Leed, MD
• Hannah Elizabeth Russell, RD, LDN, CNSC
• Zlatka Russinova, PHD
• Pooja Rutberg, MD
• William A Ruth, MD

• Dental Clinic/Center in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Dental Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2015; 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.