Provider Demographics
NPI:1114019411
Name:FORREST, ARTHUR T (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:T
Last Name:FORREST
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 1:13721 ROSWELL AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5463
Mailing Address - Country:US
Mailing Address - Phone:909-627-8544
Mailing Address - Fax:
Practice Address - Street 1:13721 ROSWELL AVE STE C
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5463
Practice Address - Country:US
Practice Address - Phone:909-627-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27278122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6443860001Medicare NSC