Provider Demographics
NPI:1790430684
Name:GREGORY A. OSBORNE DDS PA
Entity Type:Organization
Organization Name:GREGORY A. OSBORNE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-202-0692
Mailing Address - Street 1:3301 OAKWELL CT STE 102B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3075
Mailing Address - Country:US
Mailing Address - Phone:210-202-0692
Mailing Address - Fax:210-338-8747
Practice Address - Street 1:3301 OAKWELL CT STE 102B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3075
Practice Address - Country:US
Practice Address - Phone:210-202-0692
Practice Address - Fax:210-338-8747
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREGORY A. OSBORNE DDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment