Provider Demographics
NPI:1831267467
Name:OSTREM, JUSTIN TODD (DDS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:TODD
Last Name:OSTREM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:4600 LAKE RD AVE
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-536-1272
Mailing Address - Fax:763-536-1387
Practice Address - Street 1:9655 SCHMIDT LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-4530
Practice Address - Country:US
Practice Address - Phone:763-536-1272
Practice Address - Fax:763-536-1387
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN11722208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice