Healthcare Provider Details

I. General information

NPI: 1932404175
Provider Name (Legal Business Name): HEIDI BRANDT DMD MSD & STIG K OSTERBERG DDS MSD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 E 8TH ST
PORT ANGELES WA
98362-6224
US

IV. Provider business mailing address

1119 LAWRENCE ST
PORT TOWNSEND WA
98368-6525
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-7482
  • Fax: 360-457-4903
Mailing address:
  • Phone: 360-385-5121
  • Fax: 360-379-9534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE00005347
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE00005095
License Number StateWA

VIII. Authorized Official

Name: DR. STIG KJELL OSTERBERG
Title or Position: PRESIDENT
Credential: DDS MSD
Phone: 360-385-5121