Provider Demographics
NPI:1861021602
Name:OSTA, MICHELLE ELIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ELIE
Last Name:OSTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 RUTHERFORD RD # A
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-5368
Mailing Address - Country:US
Mailing Address - Phone:828-652-2731
Mailing Address - Fax:
Practice Address - Street 1:2218 RUTHERFORD RD # A
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-5368
Practice Address - Country:US
Practice Address - Phone:828-652-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC118701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice