Provider Demographics
NPI:1124132915
Name:FORREST, RUSSELL A JR (DDS)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:A
Last Name:FORREST
Suffix:JR
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 1:2300 SW 29TH ST
Mailing Address - Street 2:SUITE 221
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-1739
Mailing Address - Country:US
Mailing Address - Phone:785-266-0330
Mailing Address - Fax:
Practice Address - Street 1:2300 SW 29TH ST
Practice Address - Street 2:SUITE 221
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1739
Practice Address - Country:US
Practice Address - Phone:785-266-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS63021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice