Provider Demographics
NPI:1629190897
Name:OSBORNE, ERIC LYNN JR (DENTAL LAB TECH)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:LYNN
Last Name:OSBORNE
Suffix:JR
Gender:M
Credentials:DENTAL LAB TECH
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Mailing Address - Street 1:3129 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-2557
Mailing Address - Country:US
Mailing Address - Phone:757-395-0306
Mailing Address - Fax:757-953-8597
Practice Address - Street 1:18945 FM 2252
Practice Address - Street 2:115
Practice Address - City:GARDEN RIDGE
Practice Address - State:TX
Practice Address - Zip Code:78266-2562
Practice Address - Country:US
Practice Address - Phone:757-953-8635
Practice Address - Fax:757-953-8597
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VAT62-66-0416126900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126900000XDental ProvidersDental Laboratory Technician