MEDICARE: DR. FORREST E BLYTHE DDS

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	15728	OH

General Provider Information

NPI Number	:	1609968700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FORREST E BLYTHE DDS

Provider Business Mailing Address
First Line	:	550 MOTE DR.
Second Line	:	SUITE 1
City	:	COVINGTON
State	:	OH
Zip	:	45318
Country	:	US
Telephone Number	:	937-473-2755
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 MOTE DR
Second Line	:	SUITE 1
City	:	COVINGTON
State	:	OH
Zip	:	45318-1234
Country	:	US
Telephone Number	:	937-473-2755
Fax Number	:

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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