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NPI Code Detail

MEDICARE: FOREST DENTAL PRACTICE PLLC

MEDICARE: FOREST DENTAL PRACTICE PLLC
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
11223G0001XGeneral Practice Dentistry3218MS
21223G0001XGeneral Practice Dentistry1853MS
31223G0001XGeneral Practice Dentistry1021MS
41223G0001XGeneral Practice Dentistry2182MS

General Provider Information

NPI Number : 1427314392
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOREST DENTAL PRACTICE PLLC
Provider Business Mailing Address
First Line : PO DRAWER 30
Second Line :
City : FOREST
State : MS
Zip : 39074
Country : US
Telephone Number : 601-469-3851
Fax Number :
Provider Business Practice Location Address
First Line : 1040 HIGHWAY 35 S
Second Line :
City : FOREST
State : MS
Zip : 39074-9423
Country : US
Telephone Number : 601-469-3851
Fax Number :
Authorized Official
Title or Position : OFFICE ASSISTANT
Name : MRS. ANNE S GIBSON
Credential :
Telephone Number : 601-469-3851
Provider Enumeration Date : 04/05/2012
Last Update Date : 04/05/2012

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Directions to “FOREST DENTAL PRACTICE PLLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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