Provider Demographics
NPI:1023154713
Name:FORSBERG, RIKARD C (DDS)
Entity type:Individual
Prefix:
First Name:RIKARD
Middle Name:C
Last Name:FORSBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 STATE HIGHWAY 49
Mailing Address - Street 2:SUITE D
Mailing Address - City:COOL
Mailing Address - State:CA
Mailing Address - Zip Code:95614-9490
Mailing Address - Country:US
Mailing Address - Phone:530-888-6079
Mailing Address - Fax:530-888-6091
Practice Address - Street 1:3006 STATE HIGHWAY 49
Practice Address - Street 2:SUITE D
Practice Address - City:COOL
Practice Address - State:CA
Practice Address - Zip Code:95614-9490
Practice Address - Country:US
Practice Address - Phone:530-888-6079
Practice Address - Fax:530-888-6091
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7127350001Medicare NSC