Provider Demographics
NPI:1740368737
Name:OSTRAND, GINA FOTI (DDS)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:FOTI
Last Name:OSTRAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 RYAN ST
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-1844
Mailing Address - Country:US
Mailing Address - Phone:262-695-8600
Mailing Address - Fax:262-691-3469
Practice Address - Street 1:617 RYAN ST
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-1844
Practice Address - Country:US
Practice Address - Phone:262-695-8600
Practice Address - Fax:262-691-3469
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4447-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice