Provider Demographics
NPI:1043227978
Name:FOREST, JOSEPH E JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:FOREST
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45100 STERRITT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5843
Mailing Address - Country:US
Mailing Address - Phone:586-739-1210
Mailing Address - Fax:586-739-9451
Practice Address - Street 1:45100 STERRITT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5843
Practice Address - Country:US
Practice Address - Phone:586-739-1210
Practice Address - Fax:586-739-9451
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI145281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI14528OtherLICENSE