Provider Demographics
NPI:1962553446
Name:FOREST DENTAL CARE
Entity type:Organization
Organization Name:FOREST DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOWALEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-417-8453
Mailing Address - Street 1:6913 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4457
Mailing Address - Country:US
Mailing Address - Phone:718-417-8453
Mailing Address - Fax:718-417-1739
Practice Address - Street 1:6913 FOREST AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4457
Practice Address - Country:US
Practice Address - Phone:718-417-8453
Practice Address - Fax:718-417-1739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046206261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental