Provider Demographics
NPI:1366454647
Name:OSTERBERG, MARK N (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:N
Last Name:OSTERBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 35TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4798
Mailing Address - Country:US
Mailing Address - Phone:425-258-3509
Mailing Address - Fax:425-258-4939
Practice Address - Street 1:1426 35TH ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4798
Practice Address - Country:US
Practice Address - Phone:425-258-3509
Practice Address - Fax:425-258-4939
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000104661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice