Healthcare Provider Details

I. General information

NPI: 1730430356
Provider Name (Legal Business Name): FORREST HARRISON PEEBLES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 NW 95TH ST
SEATTLE WA
98117-2425
US

IV. Provider business mailing address

PO BOX 17830
SEATTLE WA
98127-1824
US

V. Phone/Fax

Practice location:
  • Phone: 206-789-9197
  • Fax: 206-781-0631
Mailing address:
  • Phone: 206-789-9197
  • Fax: 206-781-0631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDE00005097
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: