Provider Demographics
NPI:1649489790
Name:OSBORN, KRISTINE L (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:L
Last Name:OSBORN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:L
Other - Last Name:HALVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W3043 STATE ROAD 16
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-9032
Mailing Address - Country:US
Mailing Address - Phone:608-792-5836
Mailing Address - Fax:
Practice Address - Street 1:2830 DARLING CT
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-2754
Practice Address - Country:US
Practice Address - Phone:608-783-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice