Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 02938 | RI |
Y | 1223P0221X | Pediatric Dentist | 50253 | CA |
NPI | 1013075159 |
---|---|
Provider Name | Dr. James A Forester |
First Address | San Luis Obispo, CA 93401-2541 |
Second Address | San Luis Obispo, CA 93401-2541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 16/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02938 | LICENSE (01) | RI |
50253 | DENTAL LICENSE (01) | CA |