Provider Demographics
NPI:1093851651
Name:OSTROSKY, KEITH FRANK (DDS)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:FRANK
Last Name:OSTROSKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 15TH AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:SOUTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075
Mailing Address - Country:US
Mailing Address - Phone:651-455-5727
Mailing Address - Fax:651-455-0509
Practice Address - Street 1:351 15TH AVE N
Practice Address - Street 2:
Practice Address - City:SOUTH ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55075
Practice Address - Country:US
Practice Address - Phone:651-455-5727
Practice Address - Fax:651-455-0509
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist