Provider Demographics
NPI:1033656038
Name:FOREST CHRISTOPHER PORT DMD PA
Entity Type:Organization
Organization Name:FOREST CHRISTOPHER PORT DMD PA
Other - Org Name:ASHEVILLE SMILE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FOREST
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:PORT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:828-684-1633
Mailing Address - Street 1:600 JULIAN LN STE 610
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-7814
Mailing Address - Country:US
Mailing Address - Phone:828-684-1633
Mailing Address - Fax:828-684-1632
Practice Address - Street 1:600 JULIAN LN STE 610
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7814
Practice Address - Country:US
Practice Address - Phone:828-684-1633
Practice Address - Fax:828-684-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty