Forest Park Smiles on 11TH, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FOREST PARK SMILES ON 11TH, PLLC

Practice address

1010 W 11TH St
Panama City, FL 32401-2042

Phone

(850) 763-3622

NPI assigned

Jun 29, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan Stewart

Title

Administrator

Phone

(334) 676-2320

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498694400000",
    "number": "1013438092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3150 ZELDA CT",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361062607",
            "telephone_number": "334-676-2320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 W 11TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324012042",
            "telephone_number": "850-763-3622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST PARK SMILES ON 11TH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-29",
        "last_updated": "2017-06-29",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "334-676-2320"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Fonseca
• Curtis Foote
• Hannah Fordred, PA
• Forest Park Dental PLLC
• Forest Park Medical Associates
• Forget-Me-Not Dementia Clinic and Other Neurology Services LLC
• Anna Alise Forgue
• Tiffany Diane Forrester, M.D.
• Forst Park Dental PA
• Jenna Lee Foster, M.S., CCC-SLP

• General Practice Dentistry in Panama City, FL
• Providers in Panama City, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.