Provider Demographics
NPI:1710039334
Name:OSBORNE, GREGORY ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLEN
Last Name:OSBORNE
Suffix:
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 1:3301 OAKWELL CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218
Mailing Address - Country:US
Mailing Address - Phone:210-832-9993
Mailing Address - Fax:210-832-9186
Practice Address - Street 1:3301 OAKWELL CT
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218
Practice Address - Country:US
Practice Address - Phone:210-832-9993
Practice Address - Fax:210-832-9186
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist