Provider Demographics
NPI:1023489465
Name:THE FAIRFIELD DENTAL CLINIC
Entity type:Organization
Organization Name:THE FAIRFIELD DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:OSTHELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-283-2261
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:99012-0305
Mailing Address - Country:US
Mailing Address - Phone:509-283-2261
Mailing Address - Fax:
Practice Address - Street 1:214 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:WA
Practice Address - Zip Code:99012
Practice Address - Country:US
Practice Address - Phone:509-283-2261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 00008595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty