Provider Demographics
NPI:1992187330
Name:MARK FORREST D.M.D. P.A.
Entity Type:Organization
Organization Name:MARK FORREST D.M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-435-0100
Mailing Address - Street 1:601 N. FLAMINGO ROAD
Mailing Address - Street 2:SUITE 318
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1011
Mailing Address - Country:US
Mailing Address - Phone:954-435-0100
Mailing Address - Fax:954-430-8900
Practice Address - Street 1:601 N. FLAMINGO ROAD
Practice Address - Street 2:SUITE #318
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1011
Practice Address - Country:US
Practice Address - Phone:954-435-0100
Practice Address - Fax:954-430-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN5906122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty