Provider Demographics
NPI:1164699369
Name:FORREST, KIM K (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:K
Last Name:FORREST
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:23922 CINCO VILLAGE CTR BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6619
Mailing Address - Country:US
Mailing Address - Phone:281-392-4571
Mailing Address - Fax:281-392-8736
Practice Address - Street 1:23922 CINCO VILLAGE CTR BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6619
Practice Address - Country:US
Practice Address - Phone:281-392-4571
Practice Address - Fax:281-392-8736
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX136131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX460280OtherUNITED CONCORDIA INSURANCE COMPANY