Provider Demographics
NPI:1093399156
Name:FOREST FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:FOREST FAMILY DENTISTRY, PLLC
Other - Org Name:FOREST FAMILY DENTISTRY NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS/INSURANCE LEAD
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:EADS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-761-2223
Mailing Address - Street 1:10721 RESEARCH BLVD BLDG B180
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5694
Mailing Address - Country:US
Mailing Address - Phone:512-358-4979
Mailing Address - Fax:
Practice Address - Street 1:10721 RESEARCH BLVD BLDG B180
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5694
Practice Address - Country:US
Practice Address - Phone:512-358-4979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty