Provider Demographics
NPI:1609968700
Name:BLYTHE, FORREST E (DDS)
Entity Type:Individual
Prefix:DR
First Name:FORREST
Middle Name:E
Last Name:BLYTHE
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 1:550 MOTE DR.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COVINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45318
Mailing Address - Country:US
Mailing Address - Phone:937-473-2755
Mailing Address - Fax:
Practice Address - Street 1:550 MOTE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:COVINGTON
Practice Address - State:OH
Practice Address - Zip Code:45318-1234
Practice Address - Country:US
Practice Address - Phone:937-473-2755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH157281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice