MEDICARE: DR. ANDREW FORSTER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D8873	OR

General Provider Information

NPI Number	:	1255453791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW FORSTER DDS

Provider Business Mailing Address
First Line	:	15160 NW LAIDLAW RD
Second Line	:	SUITE 202
City	:	PORTLAND
State	:	OR
Zip	:	97229-7707
Country	:	US
Telephone Number	:	503-533-2330
Fax Number	:	503-533-2331

Provider Business Practice Location Address
First Line	:	15160 NW LAIDLAW RD
Second Line	:	SUITE 202
City	:	PORTLAND
State	:	OR
Zip	:	97229-7707
Country	:	US
Telephone Number	:	503-533-2330
Fax Number	:	503-533-2331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	06/12/2012

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