Clifton Theodore Forsberg, D.D.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DS022897L Issued in PA

Practice address

4626 Peach St
Erie, PA 16509-2007

Phone

(814) 864-0684

Fax

(814) 864-0685

NPI assigned

Dec 9, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1165622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245390509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4626 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092007",
            "telephone_number": "814-864-0684",
            "fax_number": "814-864-0685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4626 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092007",
            "telephone_number": "814-864-0684",
            "fax_number": "814-864-0685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORSBERG",
        "first_name": "CLIFTON",
        "middle_name": "THEODORE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "PA",
            "license": "DS022897L",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "OH",
            "license": "30-017451",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Foretich
• Jessica C Forge
• Michelle S Forgione
• Andrea Fornelli
• Rick Fornelli, M.D.
• Fort-Stan LLC
• Heather Leann Fortsch, RDN, LDN
• Brian K Foster, M.D.
• Chris Foster, RPH
• James Rogers Foster, PT

• Orthodontics and Dentofacial Orthopedics Dentistry in Erie, PA
• Providers in Erie, PA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.