Provider Demographics
NPI:1902897762
Name:FORNI, MARY ANNE DONATO (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANNE
Middle Name:DONATO
Last Name:FORNI
Suffix:
Gender:F
Credentials:DMD
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Mailing Address - Street 1:515 FARMERS LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4917
Mailing Address - Country:US
Mailing Address - Phone:707-527-8509
Mailing Address - Fax:707-527-8507
Practice Address - Street 1:515 FARMERS LN
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4917
Practice Address - Country:US
Practice Address - Phone:707-527-8509
Practice Address - Fax:707-527-8507
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2011-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA429951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry