Provider Demographics
NPI:1093167595
Name:FORRESTER, JUDY JOAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:JOAN
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9219 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-4854
Mailing Address - Country:US
Mailing Address - Phone:727-491-7335
Mailing Address - Fax:
Practice Address - Street 1:215 E BURLEIGH BLVD
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-2403
Practice Address - Country:US
Practice Address - Phone:352-253-6400
Practice Address - Fax:352-253-6401
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist