Provider Demographics
NPI:1518430800
Name:FORESTER DDS INC
Entity Type:Organization
Organization Name:FORESTER DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:FORESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-592-2020
Mailing Address - Street 1:620 CALIFORNIA BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2595
Mailing Address - Country:US
Mailing Address - Phone:805-592-2020
Mailing Address - Fax:805-592-2022
Practice Address - Street 1:620 CALIFORNIA BLVD STE H
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2500
Practice Address - Country:US
Practice Address - Phone:805-592-2020
Practice Address - Fax:805-592-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty