Provider Demographics
NPI:1053538272
Name:FORSBERG, TERRY WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:WAYNE
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 1:3275 APTOS RANCHO RD STE D
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3971
Mailing Address - Country:US
Mailing Address - Phone:831-685-3300
Mailing Address - Fax:831-685-1250
Practice Address - Street 1:3275 APTOS RANCHO RD STE D
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3971
Practice Address - Country:US
Practice Address - Phone:831-685-3300
Practice Address - Fax:831-685-1250
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice