# RONALD W FORSBERG

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1164520540
- **Gender:** Man
- **Credential:** DDS PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D1746 | ID | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 08/06/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000010009601 | REGENCE BLUE SHIELD OF ID | ID |
| 05 | — | 000439700 | — | ID |
| 01 | — | 67413 | BLUE CROSS OF IDAHO | ID |