Provider Demographics
NPI:1205951654
Name:OSWALD, GWEN GENETTE BIGELOW (DDS)
Entity type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:GENETTE BIGELOW
Last Name:OSWALD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:GWEN
Other - Middle Name:GENETTE
Other - Last Name:BIGELOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:124 WEST SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSET
Mailing Address - State:IA
Mailing Address - Zip Code:50273-8320
Mailing Address - Country:US
Mailing Address - Phone:515-462-2212
Mailing Address - Fax:
Practice Address - Street 1:124 WEST SUMMIT ST
Practice Address - Street 2:
Practice Address - City:WINTERSET
Practice Address - State:IA
Practice Address - Zip Code:50273-8320
Practice Address - Country:US
Practice Address - Phone:515-462-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1418574Medicaid