Provider Demographics
NPI:1114943966
Name:OSTRER, SOFIA A (DMD,MSD)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:A
Last Name:OSTRER
Suffix:
Gender:F
Credentials:DMD,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 COLLEGE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-776-7676
Mailing Address - Fax:671-776-7677
Practice Address - Street 1:30 COLLEGE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-776-7676
Practice Address - Fax:617-776-7677
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics