Provider Demographics
NPI:1437783487
Name:FORSBERG, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:FORSBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 N. OGDEN ST.
Mailing Address - Street 2:STE 260
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218
Mailing Address - Country:US
Mailing Address - Phone:863-839-5109
Mailing Address - Fax:
Practice Address - Street 1:1960 N. OGDEN ST.
Practice Address - Street 2:STE 260
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218
Practice Address - Country:US
Practice Address - Phone:863-839-5109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00204661122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist