Provider Demographics
NPI:1942427083
Name:OSSA, MARY-IBETH (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:MARY-IBETH
Middle Name:
Last Name:OSSA
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E PADONIA RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2521
Mailing Address - Country:US
Mailing Address - Phone:410-667-0884
Mailing Address - Fax:
Practice Address - Street 1:115 E PADONIA RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2521
Practice Address - Country:US
Practice Address - Phone:410-667-0884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD139301223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics