Provider Demographics
NPI:1336278274
Name:FORSBERG, ANGELA NICOLE
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:NICOLE
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:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009
Mailing Address - Country:US
Mailing Address - Phone:515-494-9576
Mailing Address - Fax:
Practice Address - Street 1:1100 N HICKORY BLVD STE 205
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-7072
Practice Address - Country:US
Practice Address - Phone:515-262-5276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08381122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist