Provider Demographics
NPI:1164541041
Name:OSBORN, DONNA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:L
Last Name:OSBORN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 LAKEWAY DR
Mailing Address - Street 2:SUITE 18A
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-4474
Mailing Address - Country:US
Mailing Address - Phone:512-261-5522
Mailing Address - Fax:512-261-7084
Practice Address - Street 1:1200 LAKEWAY DR
Practice Address - Street 2:SUITE 18A
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-4474
Practice Address - Country:US
Practice Address - Phone:512-261-5522
Practice Address - Fax:512-261-7084
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice