Provider Demographics
NPI:1477538965
Name:FORREST, STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:FORREST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:HIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2375 BERKSHIRE PKWY
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325
Mailing Address - Country:US
Mailing Address - Phone:515-987-7670
Mailing Address - Fax:515-987-7671
Practice Address - Street 1:2375 BERKSHIRE PKWY
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325
Practice Address - Country:US
Practice Address - Phone:515-987-7670
Practice Address - Fax:515-987-7671
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0021907Medicaid
012229Medicare UPIN