Healthcare Provider Details

I. General information

NPI: 1467529669
Provider Name (Legal Business Name): CRAIG JAMES FORSBERG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N LEONARD ST
WEST SALEM WI
54669-1623
US

IV. Provider business mailing address

210 N LEONARD ST
WEST SALEM WI
54669-1623
US

V. Phone/Fax

Practice location:
  • Phone: 608-786-1632
  • Fax:
Mailing address:
  • Phone: 608-786-1632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2948
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: