Provider Demographics
NPI:1508246000
Name:BRENT H. OSBORN D.M.D., P.S.
Entity Type:Organization
Organization Name:BRENT H. OSBORN D.M.D., P.S.
Other - Org Name:NORTH PINES DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:H
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-924-6262
Mailing Address - Street 1:1107 N PINES RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4936
Mailing Address - Country:US
Mailing Address - Phone:509-924-6262
Mailing Address - Fax:509-924-0091
Practice Address - Street 1:1107 N PINES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4936
Practice Address - Country:US
Practice Address - Phone:509-924-6262
Practice Address - Fax:509-924-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA72761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty