Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DE00005095 | WA |
Y | 1223P0300X | Periodontist | DE00005095 | WA |
NPI | 1134114465 |
---|---|
Provider Name | Dr. Stig K A Osterberg |
First Address | Pt Townsend, WA 98368-6525 |
Second Address | Pt Townsend, WA 98368-6525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 09/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0156577 | L AND I (01) | |
662902093 | ACA (01) |