Individual provider Active NPI

Michael Wray Ostrom, DDS

  • General Practice Dentistry
  • Oak Harbor, WA
National Provider Identifier
1134328750
Registry record updated Jul 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE00003981 Issued in WA
Practice address
950 E Whidbey Ave
Oak Harbor, WA 98277-2674
Phone
(360) 675-2857
Fax
(360) 374-5448
NPI assigned
Jul 13, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 13, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DE00003981 WA Primary

Addresses

Primary practice location

950 E Whidbey Ave
Oak Harbor, WA 98277-2674

Mailing address

950 E Whidbey Ave
Oak Harbor, WA 98277-2674
Phone (360) 675-2857

Other identifiers 1

IdentifierTypeStateIssuer
7084486MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DE00003981WAMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184284800000",
    "number": "1134328750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 E WHIDBEY AVE",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982772674",
            "telephone_number": "360-675-2857",
            "fax_number": "360-374-5448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 E WHIDBEY AVE",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982772674",
            "telephone_number": "360-675-2857",
            "fax_number": "360-374-5448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSTROM",
        "first_name": "MICHAEL",
        "middle_name": "WRAY",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-13",
        "last_updated": "2007-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00003981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7084486",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Harbor, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.