Provider Demographics
NPI:1043331861
Name:OSMOND, STEVEN WAYNE (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WAYNE
Last Name:OSMOND
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E MAIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4418
Mailing Address - Country:US
Mailing Address - Phone:804-520-0000
Mailing Address - Fax:
Practice Address - Street 1:521 E MAIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4418
Practice Address - Country:US
Practice Address - Phone:804-520-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-39621223G0001X
ND21321223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807500500Medicaid