Provider Demographics
NPI:1720494131
Name:OSTERKAMP, JAMES (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:OSTERKAMP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 W HILL RD
Mailing Address - Street 2:APT 12104
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-0982
Mailing Address - Country:US
Mailing Address - Phone:208-342-3695
Mailing Address - Fax:
Practice Address - Street 1:3250 N CAMPBELL AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-7311
Practice Address - Country:US
Practice Address - Phone:520-881-8995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID46511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice