Provider Demographics
NPI:1215168547
Name:THOMAS J. OSTLER DDS PC
Entity type:Organization
Organization Name:THOMAS J. OSTLER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JON
Authorized Official - Last Name:OSTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-796-0201
Mailing Address - Street 1:4510 S EASTERN AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6149
Mailing Address - Country:US
Mailing Address - Phone:702-796-0201
Mailing Address - Fax:702-796-0201
Practice Address - Street 1:4510 S EASTERN AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6149
Practice Address - Country:US
Practice Address - Phone:702-796-0201
Practice Address - Fax:702-796-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3366261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental