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General NPI Number Information
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NPI Number | 1073040358
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Entity Type | Individual
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Provider Name | ROSS LUCAS FORRESTER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 05/17/2017
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Provider Practice Location Address
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Address Line | 800 W FORREST AVE
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City | EUFAULA
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State | OK
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Zip | 74432-3249
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Country | US
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Telephone | 918-448-8399
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 400
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City | OKMULGEE
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State | OK
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Zip | 74447-3551
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Country | US
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Telephone | 918-448-8399
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | D009682
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License Number State | AZ
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