Ronald W Forsberg, DDS PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D1746 Issued in ID

Practice address

2005 Pine St
Sandpoint, ID 83864-9327

Phone

(208) 265-4115

Fax

(208) 265-2365

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249516800000",
    "number": "1164520540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 PINE ST",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838649327",
            "telephone_number": "208-265-4115",
            "fax_number": "208-265-2365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 PINE ST",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838649327",
            "telephone_number": "208-265-4115",
            "fax_number": "208-265-2365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORSBERG",
        "first_name": "RONALD",
        "middle_name": "W",
        "credential": "DDS PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2009-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D1746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000439700",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD OF ID",
            "identifier": "000010009601",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "67413",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Rosa Marie Fosselman, LMSW
• Curtis Edward Foster, LPC
• Laurie Foutty, ARNP
• Megan Elise Fox, PHD
• Sandra Kay Frank, MS, RD, LD, CDCES

• All providers in Sandpoint, ID
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.