Provider Demographics
NPI:1942379631
Name:OSOWA, BERNADETTE OLAMEITAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:OLAMEITAN
Last Name:OSOWA
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 1:44892 RIVERGATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-822-6302
Mailing Address - Fax:586-775-7851
Practice Address - Street 1:35409 23 MILE RD
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-3601
Practice Address - Country:US
Practice Address - Phone:586-725-9330
Practice Address - Fax:586-725-9330
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010179471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice