Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | D12698 | MN |
Y | 1223E0200X | Endodontist | D12698 | MN |
NPI | 1023342235 |
---|---|
Provider Name | Amber Jean Osiecki |
First Address | Bozeman, MT 59718 |
Second Address | Bozeman, MT 59718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2009 |
Last Update Date | 09/06/2020 |