Provider Demographics
NPI:1376791509
Name:OSDIECK, JOSEPH PATRICK (DMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PATRICK
Last Name:OSDIECK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 W ORANGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-6874
Mailing Address - Country:US
Mailing Address - Phone:602-864-5558
Mailing Address - Fax:602-864-2451
Practice Address - Street 1:2175 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE #C108
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2878
Practice Address - Country:US
Practice Address - Phone:480-782-6200
Practice Address - Fax:480-792-1444
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD76391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice