Provider Demographics
NPI:1003880709
Name:OSBORNE, JAMES W (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:222 N WINNEBAGO DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WINNEBAGO
Mailing Address - State:MO
Mailing Address - Zip Code:64034-9319
Mailing Address - Country:US
Mailing Address - Phone:816-847-2780
Mailing Address - Fax:
Practice Address - Street 1:10760 E 350 HWY
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-1815
Practice Address - Country:US
Practice Address - Phone:816-358-9691
Practice Address - Fax:816-358-5116
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0118061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO801465OtherUNITED CONCORDIA
MO12489023OtherBLUE CROSS BLUE SHIELD KC