Provider Demographics
NPI:1295430874
Name:OSBOURNE, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:OSBOURNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:(ATTN DENTAL) 1780 MARINE CORPS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA RITA
Mailing Address - State:GU
Mailing Address - Zip Code:96915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1780 MARINE CORPS DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA RITA
Practice Address - State:GU
Practice Address - Zip Code:96915
Practice Address - Country:US
Practice Address - Phone:671-339-5146
Practice Address - Fax:671-339-3277
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant