Provider Demographics
NPI:1962525261
Name:OZ FAMILY DENTISTRY, P.C.
Entity type:Organization
Organization Name:OZ FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSDOBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-387-2603
Mailing Address - Street 1:1550 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5192
Mailing Address - Country:US
Mailing Address - Phone:507-387-2603
Mailing Address - Fax:507-387-4112
Practice Address - Street 1:1550 ADAMS ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5192
Practice Address - Country:US
Practice Address - Phone:507-387-2603
Practice Address - Fax:507-387-4112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND96511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty