Provider Demographics
NPI:1659548097
Name:OSBORNE, JOSHUA THOMAS (D,M,D,)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:THOMAS
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:D,M,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7003
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-7003
Mailing Address - Country:US
Mailing Address - Phone:970-641-3004
Mailing Address - Fax:970-641-4243
Practice Address - Street 1:321 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2403
Practice Address - Country:US
Practice Address - Phone:970-641-3004
Practice Address - Fax:970-641-4243
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO94661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice