Healthcare Provider Details

I. General information

NPI: 1023508553
Provider Name (Legal Business Name): FOREST CITY FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S BROADWAY ST
FOREST CITY NC
28043-4246
US

IV. Provider business mailing address

621 S BROADWAY ST
FOREST CITY NC
28043-4246
US

V. Phone/Fax

Practice location:
  • Phone: 828-248-9100
  • Fax: 828-248-2276
Mailing address:
  • Phone: 828-248-9100
  • Fax: 828-248-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number08787
License Number StateNC

VIII. Authorized Official

Name: DR. JEFFREY D HALL
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 828-248-9100