Provider Demographics
NPI:1144419755
Name:DYKES, OSBORNE JEFFERSON IV (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:OSBORNE
Middle Name:JEFFERSON
Last Name:DYKES
Suffix:IV
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:DYKES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:1007 RR 620 S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5634
Mailing Address - Country:US
Mailing Address - Phone:512-633-7056
Mailing Address - Fax:512-351-9829
Practice Address - Street 1:1007 RR 620 S
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5634
Practice Address - Country:US
Practice Address - Phone:512-263-2993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics