MEDICARE: FOREST CITY FAMILY DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	08787	NC

General Provider Information

NPI Number	:	1023508553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREST CITY FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	621 S BROADWAY ST
Second Line	:
City	:	FOREST CITY
State	:	NC
Zip	:	28043-4246
Country	:	US
Telephone Number	:	828-248-9100
Fax Number	:	828-248-2276

Provider Business Practice Location Address
First Line	:	621 S BROADWAY ST
Second Line	:
City	:	FOREST CITY
State	:	NC
Zip	:	28043-4246
Country	:	US
Telephone Number	:	828-248-9100
Fax Number	:	828-248-2276

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. JEFFREY D HALL
Credential	:	DMD
Telephone Number	:	828-248-9100

Provider Enumeration Date	:	05/10/2018
Last Update Date	:	06/13/2023

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Directions to “FOREST CITY FAMILY DENTISTRY ” Practice Location

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