Provider Demographics
NPI:1043562549
Name:FORSE, JUDY LYNN (RDH)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:LYNN
Last Name:FORSE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:1615 TREE SAP CT STE A
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-9403
Practice Address - Country:US
Practice Address - Phone:443-944-9600
Practice Address - Fax:443-944-8550
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6642124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid