Provider Demographics
NPI:1659710259
Name:OSORIO, EDITH (DMD)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:OSORIO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 CALLE ALVERIO
Mailing Address - Street 2:ROOSEVELT EXTENSION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2619
Mailing Address - Country:US
Mailing Address - Phone:787-679-4827
Mailing Address - Fax:
Practice Address - Street 1:1800 MCRAE BOULEVARD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TEXAS
Practice Address - Zip Code:79925
Practice Address - Country:UM
Practice Address - Phone:915-592-4168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR30951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry