Forrest Garnett Bale, DDS
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · Russellville, AR
NPI 1376635375 · NPPES record last updated Oct 19, 2012
Key facts
- NPI
- 1376635375
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- License
- 3799 (AR)
- Practice address
- 319 S Glenwood Ave
Russellville, AR 72801-5906 - Phone
- (479) 968-1334
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130617000283 | AR | Order and Referring Only - Oral Surgery |
9537231337 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE00010370 | WA | MD | Oral and Maxillofacial Surgery (Dentist) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Forrest G. Bale, DDS Oral and Maxillofacial Surgery PA | Current | Accepting new patients | |
| Dr. Daniel W Skinner, P.S. | Past | Accepting new patients |
Locations
319 S Glenwood Ave
Russellville, AR 72801
Phone (479) 968-1334
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | DE00010370 | WA | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 3799 | AR | Yes |
Addresses
Primary practice location
319 S Glenwood Ave
Russellville, AR 72801-5906
Mailing address
319 S Glenwood Ave
Russellville, AR 72801-5906
Phone (479) 968-1334
Other providers in Russellville, AR
- Dustin Baker
- James Baker
- Kathleen Baker
- Sandra Lynn Baker
- Laken Nicolle Baldwin
- Angela Balentine
- Baptist Health
- Leigh Merritt Barborek
- Amy Ruth Barley
- Megan Elizabeth Barnes
All providers in Russellville, AR · Oral and Maxillofacial Surgery (Dentist) in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.