Individual
DR. MICHAEL FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D. , M.D.
Contact information
Practice address
23 MAPLE AVE, GREENWICH, CT 06830-5675
(203) 661-5858
Mailing address
23 MAPLE AVE, GREENWICH, CT 06830-5675
(203) 661-5858
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
062428
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
13252
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2016
Last updated
12/24/2022
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