Provider Demographics
NPI:1760977854
Name:FORSYTHE, NICHOLAS JON (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JON
Last Name:FORSYTHE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11302 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:TULALIP
Mailing Address - State:WA
Mailing Address - Zip Code:98271-9446
Mailing Address - Country:US
Mailing Address - Phone:425-870-8546
Mailing Address - Fax:
Practice Address - Street 1:16825 SMOKEY POINT BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8407
Practice Address - Country:US
Practice Address - Phone:360-653-5197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE608506541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice