Provider Demographics
NPI:1205826401
Name:OSOVITZ-OIEN, SUSAN MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:OSOVITZ-OIEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:MAIRE
Other - Last Name:OSOVITZ-PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1065 GUMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58204-4063
Mailing Address - Country:US
Mailing Address - Phone:701-610-3400
Mailing Address - Fax:701-594-3898
Practice Address - Street 1:3250 ZEMKE AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-5023
Practice Address - Country:US
Practice Address - Phone:813-827-9400
Practice Address - Fax:701-747-3872
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist