Provider Demographics
NPI:1407085020
Name:OSBORNE, KEVIN PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PAUL
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 BOCA CHICA BLVD
Mailing Address - Street 2:#200
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2230
Mailing Address - Country:US
Mailing Address - Phone:956-546-2983
Mailing Address - Fax:956-546-1342
Practice Address - Street 1:2334 BOCA CHICA BLVD
Practice Address - Street 2:#200
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2230
Practice Address - Country:US
Practice Address - Phone:956-546-2983
Practice Address - Fax:956-546-1342
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7809122300000X
TX250081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist