| Jeff Fordice Dds Llc | |
|
1120 Birch St Fairmont MN 56031-4418 | |
| (507) 238-4276 | |
| Not Available |
| Full Name | Jeff Fordice Dds Llc |
|---|---|
| Speciality | Dentist |
| Location | 1120 Birch St, Fairmont, Minnesota |
| Authorized Official Name and Position | Jeff Fordice (OWNER) |
| Authorized Official Contact | 5072384276 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeff Fordice Dds Llc 1120 Birch St Fairmont MN 56031-4418 Ph: (507) 238-4276 | Jeff Fordice Dds Llc 1120 Birch St Fairmont MN 56031-4418 Ph: (507) 238-4276 |
| NPI Number | 1417227828 |
|---|---|
| Provider Enumeration Date | 01/03/2012 |
| Last Update Date | 01/03/2012 |
| Medicare PECOS PAC ID | 5597144261 |
|---|---|
| Medicare Enrollment ID | O20220627001860 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417227828 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D9297 (Minnesota) | Primary |
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