Provider Demographics
NPI:1760611818
Name:OSBORN, DOROTHY RUSSELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:RUSSELL
Last Name:OSBORN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:DOROTHY
Other - Middle Name:RAYNE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5720 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35212-2522
Mailing Address - Country:US
Mailing Address - Phone:205-380-9455
Mailing Address - Fax:
Practice Address - Street 1:5720 1ST AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35212-2522
Practice Address - Country:US
Practice Address - Phone:205-380-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL56951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice