Provider Demographics
NPI:1013310242
Name:OSBORN, ELLA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELLA
Middle Name:
Last Name:OSBORN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ELLA
Other - Middle Name:BOTCHEVAR
Other - Last Name:ZIEGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:25 NORTHERN AVE UNIT 1209
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-1994
Mailing Address - Country:US
Mailing Address - Phone:781-254-6804
Mailing Address - Fax:
Practice Address - Street 1:268 SUMMER ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210
Practice Address - Country:US
Practice Address - Phone:617-752-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18565441223X0400X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics