Provider Demographics
NPI:1205943271
Name:OSORIA, JOSE LUIS (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:OSORIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 W CENTRAL AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3153
Mailing Address - Country:US
Mailing Address - Phone:714-546-6488
Mailing Address - Fax:714-546-9488
Practice Address - Street 1:1155 W CENTRAL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3153
Practice Address - Country:US
Practice Address - Phone:714-546-6488
Practice Address - Fax:714-546-9488
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
B4238901Medicare ID - Type Unspecified