Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 100271 | CA |
NPI | 1003369869 |
---|---|
Provider Name | Nicholas Charles Oster |
First Address | Camp Lejeune, NC 28542-0130 |
Second Address | Camp Lejeune, NC 28542-0130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2016 |
Last Update Date | 28/07/2016 |