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General NPI Number Information
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NPI Number | 1124773460
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Entity Type | Organization
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Legal Business Name | JUSTIN T. OSTREM D.D.S. PA
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 9655 SCHMIDT LAKE RD STE 200
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City | PLYMOUTH
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State | MN
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Zip | 55442-4530
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Country | US
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Telephone | 763-536-1272
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Fax |
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Provider Business Mailing Address
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Address Line | 9655 SCHMIDT LAKE RD STE 200
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City | PLYMOUTH
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State | MN
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Zip | 55442-4530
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Country | US
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Telephone | 763-536-1272
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUSTIN T OSTREM
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Credential | DDS
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Telephone | 763-536-1272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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