Provider Demographics
NPI:1508873118
Name:OSBERG PESOLA SCAMP KAIVO DDS PA
Entity Type:Organization
Organization Name:OSBERG PESOLA SCAMP KAIVO DDS PA
Other - Org Name:PARKWAY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GERTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-824-4211
Mailing Address - Street 1:16518 WEST 78TH STREET
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346
Mailing Address - Country:US
Mailing Address - Phone:952-937-2137
Mailing Address - Fax:952-937-5820
Practice Address - Street 1:16518 WEST 78TH STREET
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346
Practice Address - Country:US
Practice Address - Phone:952-937-2137
Practice Address - Fax:952-937-5820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty