Provider Demographics
NPI:1598157141
Name:OSBOURNE, TIANA (DDS)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:
Last Name:OSBOURNE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9017 N UNIVERSITY AVE APT 15101
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-4313
Mailing Address - Country:US
Mailing Address - Phone:845-527-8184
Mailing Address - Fax:
Practice Address - Street 1:3613 NW 56TH ST STE 105
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4520
Practice Address - Country:US
Practice Address - Phone:405-946-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058706-1122300000X
OK1261223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist