Provider Demographics
NPI:1366725699
Name:HEIDI BRANDT, DMD,MSD,&STIG OSTERBERG, DDS, MSD
Entity type:Organization
Organization Name:HEIDI BRANDT, DMD,MSD,&STIG OSTERBERG, DDS, MSD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STIG
Authorized Official - Middle Name:K
Authorized Official - Last Name:OSTERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:360-385-5121
Mailing Address - Street 1:1119 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6525
Mailing Address - Country:US
Mailing Address - Phone:360-385-5121
Mailing Address - Fax:
Practice Address - Street 1:1119 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6525
Practice Address - Country:US
Practice Address - Phone:360-385-5121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA50951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty