Provider Demographics
NPI:1659420115
Name:JERKINS, FORREST ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:FORREST
Middle Name:ROBERT
Last Name:JERKINS
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 1:3360 US HWY 27/441
Mailing Address - Street 2:SUITE A
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-4141
Mailing Address - Country:US
Mailing Address - Phone:352-728-8881
Mailing Address - Fax:352-728-2650
Practice Address - Street 1:3360 US HWY 27
Practice Address - Street 2:SUITE A
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-4141
Practice Address - Country:US
Practice Address - Phone:352-728-8881
Practice Address - Fax:352-728-2650
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10537122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist