Provider Demographics
NPI:1104036763
Name:OSTHELLER FAMILY DENITSTRY
Entity Type:Organization
Organization Name:OSTHELLER FAMILY DENITSTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTHELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-770-2836
Mailing Address - Street 1:1530 N STATE ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2905
Mailing Address - Country:US
Mailing Address - Phone:801-770-2836
Mailing Address - Fax:801-770-3103
Practice Address - Street 1:1530 N STATE ST
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043
Practice Address - Country:US
Practice Address - Phone:801-770-2836
Practice Address - Fax:801-770-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2787109922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental