Provider Demographics
NPI:1215508932
Name:OSBORNE, ANTHONY (DDS)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 HOLLY HALL ST APT 120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4147
Mailing Address - Country:US
Mailing Address - Phone:660-888-4494
Mailing Address - Fax:
Practice Address - Street 1:9701 N SAM HOUSTON PKWY E STE 240
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4636
Practice Address - Country:US
Practice Address - Phone:660-888-4494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-03
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX373591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice