Provider Demographics
NPI:1255095527
Name:OSTENDRORF, JEAN
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:OSTENDRORF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 TEAROSE CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-9628
Mailing Address - Country:US
Mailing Address - Phone:937-207-9498
Mailing Address - Fax:
Practice Address - Street 1:1763 TEAROSE CIR
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-9628
Practice Address - Country:US
Practice Address - Phone:937-207-9498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant