Healthcare Provider Details

I. General information

NPI: 1205043452
Provider Name (Legal Business Name): ROBERT J OSTROSKI D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MILL LN
FARMINGTON CT
06032-2216
US

IV. Provider business mailing address

1 MILL LN
FARMINGTON CT
06032-2216
US

V. Phone/Fax

Practice location:
  • Phone: 860-677-8031
  • Fax: 860-677-8083
Mailing address:
  • Phone: 860-677-8031
  • Fax: 860-677-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4867
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: