Provider Demographics
NPI:1972604205
Name:OSTERTAG, ALAN JAMES (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JAMES
Last Name:OSTERTAG
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4907 KEYSTONE XING
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-5144
Mailing Address - Country:US
Mailing Address - Phone:715-855-5051
Mailing Address - Fax:715-855-5052
Practice Address - Street 1:4907 KEYSTONE XING
Practice Address - Street 2:SUITE A
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-5144
Practice Address - Country:US
Practice Address - Phone:715-855-5051
Practice Address - Fax:715-855-5052
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3726-0151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics