Provider Demographics
NPI:1639121163
Name:OSBORN, THOMAS PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PATRICK
Last Name:OSBORN
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 1:1459 LANEY WALKER BLVD
Mailing Address - Street 2:AD1501
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0002
Mailing Address - Country:US
Mailing Address - Phone:706-721-0502
Mailing Address - Fax:706-721-6778
Practice Address - Street 1:1459 LANEY WALKER BLVD
Practice Address - Street 2:AD1501
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0002
Practice Address - Country:US
Practice Address - Phone:706-721-0502
Practice Address - Fax:706-721-6778
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNF0003191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1418385OtherTRICARE
SCZG0319Medicaid
GA19NCCDWMedicare ID - Type UnspecifiedGA MEDICARE
GAT82916Medicare UPIN