Healthcare Provider Details

I. General information

NPI: 1417515628
Provider Name (Legal Business Name): OSTENDORF DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S 36TH ST
SAINT JOSEPH MO
64506-2920
US

IV. Provider business mailing address

103 S 36TH ST
SAINT JOSEPH MO
64506-2920
US

V. Phone/Fax

Practice location:
  • Phone: 816-364-1186
  • Fax:
Mailing address:
  • Phone: 816-364-1186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER OSTENDORF OSTENDORF
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 218-290-1870