MEDICARE: DR. FORREST HARRISON PEEBLES 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	1223D0001X	Public Health Dentistry	DE00005097	WA

General Provider Information

NPI Number	:	1730430356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FORREST HARRISON PEEBLES DDS

Provider Business Mailing Address
First Line	:	PO BOX 17830
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98127-1824
Country	:	US
Telephone Number	:	206-789-9197
Fax Number	:	206-781-0631

Provider Business Practice Location Address
First Line	:	2110 NW 95TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-2425
Country	:	US
Telephone Number	:	206-789-9197
Fax Number	:	206-781-0631

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

Provider Enumeration Date	:	09/21/2012
Last Update Date	:	07/01/2015

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