Provider Demographics
NPI:1851819858
Name:OSGOOD, STACI NICOLE (DDS)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:NICOLE
Last Name:OSGOOD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 S BROADWAY # 8439
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:64075-8439
Mailing Address - Country:US
Mailing Address - Phone:913-558-3919
Mailing Address - Fax:
Practice Address - Street 1:2016 S BROADWAY # 8439
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075-8439
Practice Address - Country:US
Practice Address - Phone:816-690-7757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017030487122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist