Provider Demographics
NPI:1548555683
Name:OSTLER FAMILY DENTAL, PC
Entity type:Organization
Organization Name:OSTLER FAMILY DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RICKARD
Authorized Official - Last Name:OSTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-566-1310
Mailing Address - Street 1:20542 N LAKE PLEASANT RD STE 109
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-9749
Mailing Address - Country:US
Mailing Address - Phone:623-566-1310
Mailing Address - Fax:623-566-1331
Practice Address - Street 1:20542 N LAKE PLEASANT RD STE 109
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-9749
Practice Address - Country:US
Practice Address - Phone:623-566-1310
Practice Address - Fax:623-566-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty