Provider Demographics
NPI:1821330283
Name:FOERTSCH, SHARON ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ANNE
Last Name:FOERTSCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1326
Mailing Address - Country:US
Mailing Address - Phone:847-234-6440
Mailing Address - Fax:847-234-2195
Practice Address - Street 1:133 E LAUREL AVE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1326
Practice Address - Country:US
Practice Address - Phone:847-234-6440
Practice Address - Fax:847-234-2195
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019017187122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist