Provider Demographics
NPI:1730103151
Name:OSBORNE, DEREK ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ALAN
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 1:2931 ESSARY DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-2404
Mailing Address - Country:US
Mailing Address - Phone:865-687-3203
Mailing Address - Fax:865-687-3299
Practice Address - Street 1:2931 ESSARY DR
Practice Address - Street 2:SUITE #1
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2404
Practice Address - Country:US
Practice Address - Phone:865-687-3203
Practice Address - Fax:865-687-3299
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist