Provider Demographics
NPI:1710173620
Name:FORREST, DAVID LAWSON
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWSON
Last Name:FORREST
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:LAWSON
Other - Last Name:FORREST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:729 THIMBLE SHOALS BLVD
Mailing Address - Street 2:7A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4217
Mailing Address - Country:US
Mailing Address - Phone:757-873-8800
Mailing Address - Fax:757-873-2027
Practice Address - Street 1:729 THIMBLE SHOALS BLVD
Practice Address - Street 2:7A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4217
Practice Address - Country:US
Practice Address - Phone:757-873-8800
Practice Address - Fax:757-873-2027
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010059811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics