Provider Demographics
NPI:1932633864
Name:JORGE DE LA OSA DDS.,INC
Entity Type:Organization
Organization Name:JORGE DE LA OSA DDS.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA OSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-622-8818
Mailing Address - Street 1:117 W WILLOW ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-1829
Mailing Address - Country:US
Mailing Address - Phone:909-622-8818
Mailing Address - Fax:909-622-8418
Practice Address - Street 1:117 W WILLOW ST
Practice Address - Street 2:SUITE A
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-1829
Practice Address - Country:US
Practice Address - Phone:909-622-8818
Practice Address - Fax:909-622-8418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty