Provider Demographics
NPI:1336213719
Name:FOSTVEDT, CRAIG G (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:G
Last Name:FOSTVEDT
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 1:69-201 WAIKOLOA BEACH DR
Mailing Address - Street 2:SUITE 2615
Mailing Address - City:WAIKOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96738-5810
Mailing Address - Country:US
Mailing Address - Phone:808-887-1808
Mailing Address - Fax:808-887-1807
Practice Address - Street 1:69-201 WAIKOLOA BEACH DR
Practice Address - Street 2:SUITE 2615
Practice Address - City:WAIKOLOA
Practice Address - State:HI
Practice Address - Zip Code:96738-5810
Practice Address - Country:US
Practice Address - Phone:808-887-1808
Practice Address - Fax:808-887-1807
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI16061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice