Healthcare Provider Details

I. General information

NPI: 1700962941
Provider Name (Legal Business Name): FORREST HUGHES FAULCONER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 AUSTIN BLUFFS PARKWAY SUITE #315
COLORADO SPRINGS CO
80918
US

IV. Provider business mailing address

3505 AUSTIN BLUFFS PARKWAY SUITE #315
COLORADO SPRINGS CO
80918
US

V. Phone/Fax

Practice location:
  • Phone: 719-598-7862
  • Fax: 719-531-6006
Mailing address:
  • Phone: 719-576-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberC03369
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: