Healthcare Provider Details

I. General information

NPI: 1841492584
Provider Name (Legal Business Name): ROBERT H. IEZMAN, DDS AND SETH R. OSTERMAN, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST SUITE 408
BERKELEY CA
94705-2146
US

IV. Provider business mailing address

2999 REGENT ST SUITE 408
BERKELEY CA
94705-2146
US

V. Phone/Fax

Practice location:
  • Phone: 510-849-3613
  • Fax: 510-849-3658
Mailing address:
  • Phone: 510-849-3613
  • Fax: 510-849-3658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number43056
License Number StateCA

VIII. Authorized Official

Name: DR. SETH ROBERT OSTERMAN
Title or Position: GENERAL PARTNER- ORTHODONTIST
Credential: D.D.S., M.S.
Phone: 510-849-3613