Healthcare Provider Details

I. General information

NPI: 1700026010
Provider Name (Legal Business Name): MAUREEN ANN OOSTDIK R.D.H
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 E WASHINGTON AVE
MADISON WI
53704-5002
US

IV. Provider business mailing address

2705 E WASHINGTON AVE
MADISON WI
53704-5002
US

V. Phone/Fax

Practice location:
  • Phone: 608-243-0396
  • Fax: 608-246-5619
Mailing address:
  • Phone: 608-243-0396
  • Fax: 608-246-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4045-016
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: