Michael Joseph Fomich, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19794 Issued in OH

Practice address

125 E Main St.
Louisville, OH 44641

Phone

(330) 753-3007

Fax

(330) 753-3000

NPI assigned

Nov 27, 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

Other identifiers 1

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": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340755200000",
    "number": "1619043239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 E MAIN ST.",
            "city": "LOUISVILLE",
            "state": "OH",
            "postal_code": "44641",
            "telephone_number": "330-875-8027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 E MAIN ST.",
            "city": "LOUISVILLE",
            "state": "OH",
            "postal_code": "44641",
            "telephone_number": "330-753-3007",
            "fax_number": "330-753-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOMICH",
        "first_name": "MICHAEL",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-27",
        "last_updated": "2012-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "19794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0965988",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Louisville, OH
• Providers in Louisville, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2012; 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.