Provider Demographics
NPI:1720267834
Name:BOOZER, FORREST RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:FORREST
Middle Name:RYAN
Last Name:BOOZER
Suffix:
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 1:2530 CAMEO DR
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-9000
Mailing Address - Country:US
Mailing Address - Phone:530-676-9999
Mailing Address - Fax:
Practice Address - Street 1:2530 CAMEO DR
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-9000
Practice Address - Country:US
Practice Address - Phone:530-676-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice