Healthcare Provider Details

I. General information

NPI: 1205826401
Provider Name (Legal Business Name): SUSAN MARIE OSOVITZ-OIEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN MAIRE OSOVITZ-PETERS DDS

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 ZEMKE AVE
TAMPA FL
33621-5023
US

IV. Provider business mailing address

1065 GUMWOOD AVE
GRAND FORKS ND
58204-4063
US

V. Phone/Fax

Practice location:
  • Phone: 813-827-9400
  • Fax: 701-747-3872
Mailing address:
  • Phone: 701-610-3400
  • Fax: 701-594-3898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16594
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: