Individual
EDMISE FORESTAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1839 CENTRAL AVE, ALBANY, NY 12205-4748
(518) 464-0402
(518) 464-0409
Mailing address
415 N GRAND AVE, PUEBLO, CO 81003-3111
(719) 583-1800
(719) 583-1801
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
052278
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02772094
—
NY
01
—
10115236
CDPHP
NY
01
—
9184483
DORAL
NY
Enumeration date
01/28/2006
Last updated
07/09/2007
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