Provider Demographics
NPI:1457514499
Name:OSBORNE, RACHEL GLYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:GLYNN
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:LOCUST FORK
Mailing Address - State:AL
Mailing Address - Zip Code:35097
Mailing Address - Country:US
Mailing Address - Phone:205-681-3050
Mailing Address - Fax:256-259-0017
Practice Address - Street 1:29984 STATE HWY 79
Practice Address - Street 2:SUITE 300
Practice Address - City:LOCUST FORK
Practice Address - State:AL
Practice Address - Zip Code:35097
Practice Address - Country:US
Practice Address - Phone:205-681-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5624122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist