Healthcare Provider Details

I. General information

NPI: 1710173620
Provider Name (Legal Business Name): DR. DAVID LAWSON FORREST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. DAVID LAWSON FORREST

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 THIMBLE SHOALS BLVD 7A
NEWPORT NEWS VA
23606-4217
US

IV. Provider business mailing address

729 THIMBLE SHOALS BLVD 7A
NEWPORT NEWS VA
23606-4217
US

V. Phone/Fax

Practice location:
  • Phone: 757-873-8800
  • Fax: 757-873-2027
Mailing address:
  • Phone: 757-873-8800
  • Fax: 757-873-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401005981
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: