Provider Demographics
NPI:1598790321
Name:OSTBERG, RICHARD CARL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CARL
Last Name:OSTBERG
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 1:617 MILL ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-1775
Mailing Address - Country:US
Mailing Address - Phone:508-756-0358
Mailing Address - Fax:508-756-7301
Practice Address - Street 1:617 MILL ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-1775
Practice Address - Country:US
Practice Address - Phone:508-756-0358
Practice Address - Fax:508-756-7301
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA137291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice