Provider Demographics
NPI:1366450371
Name:OSBORNE, THOMAS E (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:OSBORNE
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Gender:M
Credentials:DDS
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Mailing Address - Street 1:2295 PARKLAKE DR NE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2844
Mailing Address - Country:US
Mailing Address - Phone:770-723-9965
Mailing Address - Fax:770-270-6851
Practice Address - Street 1:2295 PARKLAKE DR NE
Practice Address - Street 2:SUITE 240
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2844
Practice Address - Country:US
Practice Address - Phone:770-723-9965
Practice Address - Fax:770-270-6851
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-08-03
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Provider Licenses
StateLicense IDTaxonomies
GA10606204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T97765Medicare UPIN
T97765Medicare UPIN