Provider Demographics
NPI:1306067038
Name:FORSTER, ADAM L (DDS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:L
Last Name:FORSTER
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 1:1132 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-1609
Mailing Address - Country:US
Mailing Address - Phone:920-623-5559
Mailing Address - Fax:920-623-0127
Practice Address - Street 1:1132 PARK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-1609
Practice Address - Country:US
Practice Address - Phone:920-623-5559
Practice Address - Fax:920-623-0127
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5372-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice