Provider Demographics
NPI:1164440038
Name:PAGETT, FOREST REED (DMD)
Entity Type:Individual
Prefix:DR
First Name:FOREST
Middle Name:REED
Last Name:PAGETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-1362
Mailing Address - Country:US
Mailing Address - Phone:706-342-3636
Mailing Address - Fax:
Practice Address - Street 1:139 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-1362
Practice Address - Country:US
Practice Address - Phone:706-342-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00528701AMedicaid