Provider Demographics
NPI:1255464343
Name:FOREST TRAIL DENTAL CARE
Entity Type:Organization
Organization Name:FOREST TRAIL DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-778-5070
Mailing Address - Street 1:4206 LOWES DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3498
Mailing Address - Country:US
Mailing Address - Phone:254-778-5070
Mailing Address - Fax:
Practice Address - Street 1:4206 LOWES DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3498
Practice Address - Country:US
Practice Address - Phone:254-778-5070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental