Provider Demographics
NPI:1083394225
Name:OSOWA DENTAL, PLLC
Entity Type:Organization
Organization Name:OSOWA DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:O
Authorized Official - Last Name:OSOWA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-822-6302
Mailing Address - Street 1:44892 RIVERGATE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1384
Mailing Address - Country:US
Mailing Address - Phone:586-822-6302
Mailing Address - Fax:
Practice Address - Street 1:35409 23 MILE RD
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-3601
Practice Address - Country:US
Practice Address - Phone:586-725-9330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty