Provider Demographics
NPI:1619975265
Name:OSBORNE, ELBERT PLUMMER JR (DDS)
Entity Type:Individual
Prefix:
First Name:ELBERT
Middle Name:PLUMMER
Last Name:OSBORNE
Suffix:JR
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 1:174 FAIRMONT CICLE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-5211
Mailing Address - Country:US
Mailing Address - Phone:434-792-7405
Mailing Address - Fax:
Practice Address - Street 1:4821 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-5537
Practice Address - Country:US
Practice Address - Phone:434-822-0500
Practice Address - Fax:434-822-1330
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010031491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice