Provider Demographics
NPI:1366560500
Name:PORT, FOREST CHRISTOPHER (DMD)
Entity type:Individual
Prefix:DR
First Name:FOREST
Middle Name:CHRISTOPHER
Last Name:PORT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-2305
Mailing Address - Country:US
Mailing Address - Phone:828-693-5245
Mailing Address - Fax:828-698-3631
Practice Address - Street 1:1645 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-2305
Practice Address - Country:US
Practice Address - Phone:828-693-5245
Practice Address - Fax:828-698-3631
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice