Provider Demographics
NPI:1629212758
Name:OSBORN, JOSEPH PERRIN (LD)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PERRIN
Last Name:OSBORN
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N PINES RD
Mailing Address - Street 2:MAIN LEVEL
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5120
Mailing Address - Country:US
Mailing Address - Phone:509-922-1885
Mailing Address - Fax:
Practice Address - Street 1:303 N PINES RD
Practice Address - Street 2:MAIN LEVEL
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5120
Practice Address - Country:US
Practice Address - Phone:509-922-1885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADENR.DN.60073340122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist