Provider Demographics
NPI:1346530045
Name:OSBORN, DEBORAH KAYE (RDA, RDH, RDHAP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:KAYE
Last Name:OSBORN
Suffix:
Gender:F
Credentials:RDA, RDH, RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17094
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2870
Mailing Address - Country:US
Mailing Address - Phone:775-851-6018
Mailing Address - Fax:775-851-6013
Practice Address - Street 1:1615 GHETTIS WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5032
Practice Address - Country:US
Practice Address - Phone:775-851-6018
Practice Address - Fax:775-851-6013
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22249124Q00000X
NV101046124Q00000X
CA05238126800000X
AK2079124Q00000X
CA367124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant