Provider Demographics
NPI:1841515319
Name:EMMANUEL OSORIO, DDS, INC.
Entity type:Organization
Organization Name:EMMANUEL OSORIO, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OSORIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-962-1200
Mailing Address - Street 1:5423 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7418
Mailing Address - Country:US
Mailing Address - Phone:916-962-1200
Mailing Address - Fax:
Practice Address - Street 1:5423 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7418
Practice Address - Country:US
Practice Address - Phone:916-962-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55707122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty