Provider Demographics
NPI:1164866042
Name:OSTIAGO, ANDREA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:OSTIAGO
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 1:10850 71ST AVE APT 5B
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4523
Mailing Address - Country:US
Mailing Address - Phone:718-880-1251
Mailing Address - Fax:
Practice Address - Street 1:10850 71ST AVE APT 5B
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4523
Practice Address - Country:US
Practice Address - Phone:718-880-1251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program