MEDICARE: DR. CRAIG G FOSTVEDT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1606	HI

General Provider Information

NPI Number	:	1336213719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG G FOSTVEDT DDS

Provider Business Mailing Address
First Line	:	69-201 WAIKOLOA BEACH DR
Second Line	:	SUITE 2615
City	:	WAIKOLOA
State	:	HI
Zip	:	96738-5810
Country	:	US
Telephone Number	:	808-887-1808
Fax Number	:	808-887-1807

Provider Business Practice Location Address
First Line	:	69-201 WAIKOLOA BEACH DR
Second Line	:	SUITE 2615
City	:	WAIKOLOA
State	:	HI
Zip	:	96738-5810
Country	:	US
Telephone Number	:	808-887-1808
Fax Number	:	808-887-1807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	09/13/2013

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