Provider Demographics
NPI:1578678637
Name:OSBORN, ANGELA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:OSBORN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:L
Other - Last Name:WEIMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9105 KIMMER DR
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-8454
Mailing Address - Country:US
Mailing Address - Phone:303-799-9993
Mailing Address - Fax:
Practice Address - Street 1:9105 KIMMER DR
Practice Address - Street 2:STE. 106
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-8454
Practice Address - Country:US
Practice Address - Phone:303-799-9993
Practice Address - Fax:303-799-9998
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO76471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7641OtherLICENSE NUMBER
CO7641OtherLICENSE NUMBER