Provider Demographics
NPI:1073739934
Name:FORBES, MATTHEW SPENCER (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SPENCER
Last Name:FORBES
Suffix:
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 1:5830 NALL AVE
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2730
Mailing Address - Country:US
Mailing Address - Phone:913-432-3112
Mailing Address - Fax:913-432-5467
Practice Address - Street 1:5830 NALL AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2730
Practice Address - Country:US
Practice Address - Phone:913-432-3112
Practice Address - Fax:913-432-5467
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS600751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice