Provider Demographics
NPI:1558599670
Name:OSORIO, CHRISTOPHER RYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RYAN
Last Name:OSORIO
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 1:6709 COLONNADE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6118
Mailing Address - Country:US
Mailing Address - Phone:321-433-1022
Mailing Address - Fax:321-433-1032
Practice Address - Street 1:6709 COLONNADE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-6118
Practice Address - Country:US
Practice Address - Phone:321-433-1022
Practice Address - Fax:321-433-1032
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice