Provider Demographics
NPI:1598146920
Name:FOREST DENTAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:FOREST DENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:FOREST
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-739-1210
Mailing Address - Street 1:45100 STERRITT ST.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5846
Mailing Address - Country:US
Mailing Address - Phone:586-739-1210
Mailing Address - Fax:
Practice Address - Street 1:45100 STERRITT ST.
Practice Address - Street 2:SUITE 101
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5846
Practice Address - Country:US
Practice Address - Phone:586-739-1210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI145281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE74280OtherEIN 80-0730168