| Doctor Name: | DR. JUSTIN TODD OSTREM |
| NPI Number: | 1831267467 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DDS |
| License Number: | 11722 |
| Business Practice Address: | 4600 Lake Rd Ave Robbinsdale, MN - 55422 |
| Business Phone Number: | 7635361272 |
| Business Fax Number: | 7635361387 |
| Mailing Address: | 4600 Lake Rd Ave, ROBBINSDALE |
| State: | MN |
| Postal Code: | 55422 |
| Phone Number: | 7635361272 |
| Fax Number: | 7635361387 |
| NPI Enumeration Date: | 12/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 11722 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |