MEDICARE: DR. LAURIE ANN FOREST D.D.S.

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	1223G0001X	General Practice Dentistry	016-0002007	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235169954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE ANN FOREST D.D.S.

Provider Business Mailing Address
First Line	:	81 RIVER ST
Second Line	:
City	:	MONTPELIER
State	:	VT
Zip	:	05602-3792
Country	:	US
Telephone Number	:	802-229-0033
Fax Number	:	802-229-0031

Provider Business Practice Location Address
First Line	:	81 RIVER ST
Second Line	:
City	:	MONTPELIER
State	:	VT
Zip	:	05602-3792
Country	:	US
Telephone Number	:	802-229-0033
Fax Number	:	802-229-0031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/08/2007

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