Provider Demographics
NPI:1568939163
Name:OSORIO SOUTH BOSTON DENTAL GROUP DMD PC
Entity Type:Organization
Organization Name:OSORIO SOUTH BOSTON DENTAL GROUP DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSORIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSCD
Authorized Official - Phone:617-268-1030
Mailing Address - Street 1:60 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-2510
Mailing Address - Country:US
Mailing Address - Phone:617-423-6165
Mailing Address - Fax:617-426-0006
Practice Address - Street 1:60 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-2510
Practice Address - Country:US
Practice Address - Phone:617-423-6165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty