Provider Demographics
NPI:1225146525
Name:FORSBERG, ERIC JON (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JON
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 1:2575 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1729
Mailing Address - Country:US
Mailing Address - Phone:515-967-3046
Mailing Address - Fax:515-957-9573
Practice Address - Street 1:2575 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1729
Practice Address - Country:US
Practice Address - Phone:515-967-3046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA82021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA34709OtherWELLMARK BLUEDENTAL
1489335OtherUNITED CONCORDIA
IA0290619Medicaid