Provider Demographics
NPI:1841896792
Name:FOREST HILL FAMILY ORTHODONTICS, PLLC
Entity type:Organization
Organization Name:FOREST HILL FAMILY ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-803-9351
Mailing Address - Street 1:3472 FOREST HILL BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5864
Mailing Address - Country:US
Mailing Address - Phone:561-328-1555
Mailing Address - Fax:
Practice Address - Street 1:3472 FOREST HILL BLVD STE 1
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5864
Practice Address - Country:US
Practice Address - Phone:561-328-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1194057620OtherNPI