Provider Demographics
NPI:1750479010
Name:OSBORNE, EDWARD DALE (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DALE
Last Name:OSBORNE
Suffix:
Gender:M
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:PO BOX 335
Mailing Address - Street 2:3219 STATE ROUTE 257
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346
Mailing Address - Country:US
Mailing Address - Phone:814-676-2259
Mailing Address - Fax:814-676-2034
Practice Address - Street 1:3219 STATE ROUTE 257
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16246
Practice Address - Country:US
Practice Address - Phone:814-676-2259
Practice Address - Fax:814-676-2034
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021380L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist