Individual
DR. WAYNE W. OSTDICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
N64W24050 MAIN ST, SUITE 200, SUSSEX, WI 53089-3071
(262) 820-0825
Mailing address
PO BOX 82, SUSSEX, WI 53089-0082
(262) 820-0825
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
WI 4556
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WI 4556
DENTIST LICENSE NUMBER
WI
Enumeration date
08/31/2006
Last updated
07/08/2007
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