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General NPI Number Information
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NPI Number | 1659660298
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Entity Type | Organization
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Legal Business Name | ST. ANTHONY VILLAGE DENTAL CARE, P.A.
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 2525 33RD AVE NE
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City | ST ANTHONY
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State | MN
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Zip | 55418-1539
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Country | US
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Telephone | 612-781-9270
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 33RD AVE NE
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City | ST ANTHONY
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State | MN
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Zip | 55418-1539
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Country | US
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Telephone | 612-781-9270
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH B OSTERBAUER
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Credential | D.D.S.
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Telephone | 612-781-9270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D10494
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License Number State | MN
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