Provider Demographics
NPI:1407858194
Name:OSBORN, THOMAS
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:OSBORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 SARTORI AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2717
Mailing Address - Country:US
Mailing Address - Phone:310-320-1471
Mailing Address - Fax:310-320-7645
Practice Address - Street 1:1270 SARTORI AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2717
Practice Address - Country:US
Practice Address - Phone:310-320-1471
Practice Address - Fax:310-320-7645
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31349122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist