Provider Demographics
NPI:1023342235
Name:OSIECKI, AMBER JEAN (DDS, MS)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:JEAN
Last Name:OSIECKI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:JEAN
Other - Last Name:ZEDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BOZEMAN ENDODONTICS
Mailing Address - Street 2:2055 N 22ND AVE. STE #3
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718
Mailing Address - Country:US
Mailing Address - Phone:406-587-7668
Mailing Address - Fax:406-587-7670
Practice Address - Street 1:BOZEMAN ENDODONTICS
Practice Address - Street 2:2055 N 22ND AVE STE. #3
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718
Practice Address - Country:US
Practice Address - Phone:406-587-7668
Practice Address - Fax:406-587-7670
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12698122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist