Provider Demographics
NPI:1265605588
Name:OSTERBAUER, JOSEPH B (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:B
Last Name:OSTERBAUER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 33RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-1539
Mailing Address - Country:US
Mailing Address - Phone:612-781-9270
Mailing Address - Fax:
Practice Address - Street 1:2525 33RD AVE NE
Practice Address - Street 2:
Practice Address - City:ST ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-1539
Practice Address - Country:US
Practice Address - Phone:612-781-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND104941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice