Individual
DR. JACK EDGAR OSTERHAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2424 CHARTRES STREET, LASALLE, IL 61301-1107
(815) 223-6013
Mailing address
2424 CHARTRES STREET, LASALLE, IL 61301-1107
(815) 223-6013
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.029567
IL
Other
Enumeration date
08/05/2013
Last updated
08/05/2013
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