Provider Demographics
NPI:1083771166
Name:OSBORN, ROBERTA C (DDS)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:C
Last Name:OSBORN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 MCGEE ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3217
Mailing Address - Country:US
Mailing Address - Phone:336-513-2256
Mailing Address - Fax:
Practice Address - Street 1:319 N GRAHAM HOPEDALE RD FL B
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2992
Practice Address - Country:US
Practice Address - Phone:336-513-2259
Practice Address - Fax:336-513-5593
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7792122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist