Provider Demographics
NPI:1336186618
Name:DE LA OSA, JORGE C (DDS)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:C
Last Name:DE LA OSA
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 1:4126 SEA MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-6310
Mailing Address - Country:US
Mailing Address - Phone:786-253-4599
Mailing Address - Fax:
Practice Address - Street 1:7315 STOCKTON BLVD
Practice Address - Street 2:SUITE # 3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2731
Practice Address - Country:US
Practice Address - Phone:916-422-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist