Provider Demographics
NPI:1790127173
Name:NEWSOM FORESTER DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:NEWSOM FORESTER DENTAL PARTNERSHIP
Other - Org Name:COASTAL PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:FORESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-592-2020
Mailing Address - Street 1:620 CALIFORNIA BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2541
Mailing Address - Country:US
Mailing Address - Phone:805-592-2020
Mailing Address - Fax:805-592-2022
Practice Address - Street 1:620 CALIFORNIA BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2541
Practice Address - Country:US
Practice Address - Phone:805-592-2020
Practice Address - Fax:805-592-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA502531223P0221X
CA558231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty