Provider Demographics
NPI:1578511796
Name:OSBORN, GORDON ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:ROBERT
Last Name:OSBORN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 TRUXTUN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0691
Mailing Address - Country:US
Mailing Address - Phone:661-322-9885
Mailing Address - Fax:661-322-7736
Practice Address - Street 1:4260 TRUXTUN AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0691
Practice Address - Country:US
Practice Address - Phone:661-322-9885
Practice Address - Fax:661-322-7736
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29732OtherSTATE LICENSE NUMBER
CAAO1096709OtherDEA NUMBER
CA29732OtherSTATE LICENSE NUMBER