Healthcare Provider Details

I. General information

NPI: 1104853886
Provider Name (Legal Business Name): CHARLES M. OSTER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 ELMWOOD AVE
ROCHESTER NY
14620-2913
US

IV. Provider business mailing address

61 BONITA DR
ROCHESTER NY
14616-1013
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-1129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number034283
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: