Healthcare Provider Details

I. General information

NPI: 1235169954
Provider Name (Legal Business Name): LAURIE ANN FOREST D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 RIVER ST
MONTPELIER VT
05602-3792
US

IV. Provider business mailing address

81 RIVER ST
MONTPELIER VT
05602-3792
US

V. Phone/Fax

Practice location:
  • Phone: 802-229-0033
  • Fax: 802-229-0031
Mailing address:
  • Phone: 802-229-0033
  • Fax: 802-229-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number016-0002007
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: