Healthcare Provider Details

I. General information

NPI: 1841896792
Provider Name (Legal Business Name): FOREST HILL FAMILY ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3472 FOREST HILL BLVD STE 1
WEST PALM BEACH FL
33406-5864
US

IV. Provider business mailing address

3472 FOREST HILL BLVD STE 1
WEST PALM BEACH FL
33406-5864
US

V. Phone/Fax

Practice location:
  • Phone: 561-328-1555
  • Fax:
Mailing address:
  • Phone: 561-328-1555
  • Fax:

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: MR. DAVID SHUTTS
Title or Position: CEO
Credential:
Phone: 954-803-9351