Provider Demographics
NPI:1144366956
Name:KROSCHEL, FORREST TIMOTHY (DDS)
Entity type:Individual
Prefix:
First Name:FORREST
Middle Name:TIMOTHY
Last Name:KROSCHEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 N TEXANA ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:HALLETTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77964-2021
Mailing Address - Country:US
Mailing Address - Phone:361-798-4151
Mailing Address - Fax:361-798-9088
Practice Address - Street 1:1406 N TEXANA ST
Practice Address - Street 2:SUITE F
Practice Address - City:HALLETTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77964-2021
Practice Address - Country:US
Practice Address - Phone:361-798-4151
Practice Address - Fax:361-798-9088
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice