Healthcare Provider Details

I. General information

NPI: 1811077381
Provider Name (Legal Business Name): M SCOTT OSTLER DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 JADWIN AVE
RICHLAND WA
99354-2902
US

IV. Provider business mailing address

1520 JADWIN AVE
RICHLAND WA
99354-2902
US

V. Phone/Fax

Practice location:
  • Phone: 509-943-2505
  • Fax: 509-943-9072
Mailing address:
  • Phone: 509-943-2505
  • Fax: 509-943-9072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6674
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: