Provider Demographics
NPI:1063545903
Name:OOSTBURG FAMILY DENTISTRY, L.L.C
Entity type:Organization
Organization Name:OOSTBURG FAMILY DENTISTRY, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:GUZZETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-564-2925
Mailing Address - Street 1:19 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OOSTBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53070-1250
Mailing Address - Country:US
Mailing Address - Phone:920-564-2925
Mailing Address - Fax:920-564-6407
Practice Address - Street 1:19 N 4TH ST
Practice Address - Street 2:
Practice Address - City:OOSTBURG
Practice Address - State:WI
Practice Address - Zip Code:53070-1250
Practice Address - Country:US
Practice Address - Phone:920-564-2925
Practice Address - Fax:920-564-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty