MEDICARE: MARK FORREST D.M.D. P.A.

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	122300000X	Dentist	DN5906	FL

General Provider Information

NPI Number	:	1992187330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK FORREST D.M.D. P.A.

Provider Business Mailing Address
First Line	:	601 N. FLAMINGO ROAD
Second Line	:	SUITE 318
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-1011
Country	:	US
Telephone Number	:	954-435-0100
Fax Number	:	954-430-8900

Provider Business Practice Location Address
First Line	:	601 N. FLAMINGO ROAD
Second Line	:	SUITE #318
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-1011
Country	:	US
Telephone Number	:	954-435-0100
Fax Number	:	954-430-8900

Authorized Official
Title or Position	:	DR.
Name	:	MR. MARK B. FORREST
Credential	:	D.M.D.
Telephone Number	:	954-435-0100

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	06/22/2015

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