Provider Demographics
NPI:1316003254
Name:FORBES, OWEN MEYER (DDS)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:MEYER
Last Name:FORBES
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 1:2350 NORTHPARK
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-4466
Mailing Address - Country:US
Mailing Address - Phone:812-372-7312
Mailing Address - Fax:812-378-9451
Practice Address - Street 1:2350 NORTHPARK
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-4466
Practice Address - Country:US
Practice Address - Phone:812-372-7312
Practice Address - Fax:812-378-9451
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120099941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000192308OtherBCBS
INU68092Medicare UPIN
IN052940DMedicare PIN