Provider Demographics
NPI:1164088993
Name:OSDOBA, GRETCHEN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:M
Last Name:OSDOBA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5192
Mailing Address - Country:US
Mailing Address - Phone:507-387-2603
Mailing Address - Fax:
Practice Address - Street 1:1550 ADAMS ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5192
Practice Address - Country:US
Practice Address - Phone:507-387-2603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist