Provider Demographics
NPI:1255085684
Name:GRANT B OSEROWSKY DDS PLLC
Entity type:Organization
Organization Name:GRANT B OSEROWSKY DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:OSEROWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-825-4000
Mailing Address - Street 1:10 W OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9530
Mailing Address - Country:US
Mailing Address - Phone:417-825-4000
Mailing Address - Fax:
Practice Address - Street 1:1404 SE EAGLE WAY STE 2
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4841
Practice Address - Country:US
Practice Address - Phone:479-553-9202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental