Provider Demographics
NPI:1205043452
Name:OSTROSKI, ROBERT J (DDS,MS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:OSTROSKI
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MILL LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2216
Mailing Address - Country:US
Mailing Address - Phone:860-677-8031
Mailing Address - Fax:860-677-8083
Practice Address - Street 1:1 MILL LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2216
Practice Address - Country:US
Practice Address - Phone:860-677-8031
Practice Address - Fax:860-677-8083
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT48671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics