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General NPI Number Information
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NPI Number | 1851636708
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Entity Type | Organization
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Legal Business Name | FOREST FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 12/04/2012
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Last Update Date | 01/24/2013
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Provider Practice Location Address
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Address Line | 2700 W ANDERSON LN UNIT 418
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City | AUSTIN
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State | TX
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Zip | 78757-1159
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Country | US
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Telephone | 512-808-7464
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 W ANDERSON LN UNIT 418
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City | AUSTIN
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State | TX
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Zip | 78757-1159
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Country | US
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Telephone | 512-808-7464
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. ROBIN BETHELL
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Credential | DDS
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Telephone | 512-808-7464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25813
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License Number State | TX
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