Healthcare Provider Details

I. General information

NPI: 1336213719
Provider Name (Legal Business Name): CRAIG G FOSTVEDT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69-201 WAIKOLOA BEACH DR SUITE 2615
WAIKOLOA HI
96738-5810
US

IV. Provider business mailing address

69-201 WAIKOLOA BEACH DR SUITE 2615
WAIKOLOA HI
96738-5810
US

V. Phone/Fax

Practice location:
  • Phone: 808-887-1808
  • Fax: 808-887-1807
Mailing address:
  • Phone: 808-887-1808
  • Fax: 808-887-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1606
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: