Provider Demographics
NPI:1336290329
Name:FORBES, DOUGLAS ROY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ROY
Last Name:FORBES
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:PO BOX 210415
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29221-0415
Mailing Address - Country:US
Mailing Address - Phone:803-798-1670
Mailing Address - Fax:803-798-4226
Practice Address - Street 1:1061 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5829
Practice Address - Country:US
Practice Address - Phone:803-798-1670
Practice Address - Fax:803-798-4226
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice