Provider Demographics
NPI:1134424377
Name:JAMES J OSTERHAUS DDS PC
Entity type:Organization
Organization Name:JAMES J OSTERHAUS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:OSTERHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-252-1932
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:IA
Mailing Address - Zip Code:52052-0198
Mailing Address - Country:US
Mailing Address - Phone:563-252-1932
Mailing Address - Fax:
Practice Address - Street 1:402 S RIVER PARK DR
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:IA
Practice Address - Zip Code:52052-7720
Practice Address - Country:US
Practice Address - Phone:563-252-1932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7014122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1376617738Medicaid