Provider Demographics
NPI:1215947577
Name:OSBOURNE-SMART, DANETTE E (DDS, MS, PLLC)
Entity type:Individual
Prefix:
First Name:DANETTE
Middle Name:E
Last Name:OSBOURNE-SMART
Suffix:
Gender:F
Credentials:DDS, MS, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 UNIVERSITY EXEC PARK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3380
Mailing Address - Country:US
Mailing Address - Phone:704-549-8878
Mailing Address - Fax:704-549-1088
Practice Address - Street 1:8220 UNIVERSITY EXEC PARK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3380
Practice Address - Country:US
Practice Address - Phone:704-549-8878
Practice Address - Fax:704-549-1088
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899019AMedicaid