Healthcare Provider Details

I. General information

NPI: 1417300187
Provider Name (Legal Business Name): CARL OSTERGREN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8511 GREENWOOD AVE N
SEATTLE WA
98103-3613
US

IV. Provider business mailing address

8511 GREENWOOD AVE N
SEATTLE WA
98103-3613
US

V. Phone/Fax

Practice location:
  • Phone: 206-782-8223
  • Fax:
Mailing address:
  • Phone: 206-782-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60665085
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: