Provider Demographics
NPI:1194205443
Name:OSBORN, ANDREW BAXTER (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:BAXTER
Last Name:OSBORN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 MAYNARDVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:MAYNARDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37807-3413
Mailing Address - Country:US
Mailing Address - Phone:865-992-5821
Mailing Address - Fax:865-992-3042
Practice Address - Street 1:3802 MAYNARDVILLE HWY
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807-3413
Practice Address - Country:US
Practice Address - Phone:865-992-5821
Practice Address - Fax:865-992-3042
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS108481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice