Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 4020 | WA |
NPI | 1003954264 |
---|---|
Provider Name | Dr. John T Forrester |
First Address | Aberdeen, WA 98520-3947 |
Second Address | Aberdeen, WA 98520-3947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5370408 | DSHS PROVIDER (01) | WA |