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Organization

FOREST DENTAL PRACTICE PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN B SMITH DMD (OWNER)
(601) 469-3851
Entity
Organization

Contact information

Practice address
PO DRAWER 30, FOREST, MS 39074
(601) 469-3851
(601) 469-4356
Mailing address
PO BOX 30, FOREST, MS 39074-0030
(601) 469-3851
(601) 469-4356

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
09015012
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09015012
MS
Enumeration date
01/12/2007
Last updated
08/22/2020
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