Provider Demographics
NPI:1487805305
Name:FAMILY DENTISTRY, JOSEPH L. OSTHELLER DDS
Entity type:Organization
Organization Name:FAMILY DENTISTRY, JOSEPH L. OSTHELLER DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:OSTHELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-874-6846
Mailing Address - Street 1:3280 SE LUND
Mailing Address - Street 2:#8
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366
Mailing Address - Country:US
Mailing Address - Phone:360-874-6846
Mailing Address - Fax:360-874-6853
Practice Address - Street 1:3280 SE LUND
Practice Address - Street 2:#8
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366
Practice Address - Country:US
Practice Address - Phone:360-874-6846
Practice Address - Fax:360-874-6853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE85951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5044342OtherDSHS PROVIDER # FOR PERFORMING DR JOSEPH OSTHELLER
WA5032826OtherCORE/GROUP PROVIDER #