Healthcare Provider Details

I. General information

NPI: 1518430800
Provider Name (Legal Business Name): FORESTER DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 CALIFORNIA BLVD STE H
SAN LUIS OBISPO CA
93401-2500
US

IV. Provider business mailing address

620 CALIFORNIA BLVD STE G
SAN LUIS OBISPO CA
93401-2595
US

V. Phone/Fax

Practice location:
  • Phone: 805-592-2020
  • Fax: 805-592-2022
Mailing address:
  • Phone: 805-592-2020
  • Fax: 805-592-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES ALEXANDER FORESTER
Title or Position: PRESIDENT
Credential: DDS
Phone: 805-592-2020