Provider Demographics
NPI:1407646912
Name:DENTAL OFFICE DE LA OSA DDS INC
Entity type:Organization
Organization Name:DENTAL OFFICE DE LA OSA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DE LA OSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-660-1921
Mailing Address - Street 1:929 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:UPKAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-966-0192
Mailing Address - Fax:909-660-1864
Practice Address - Street 1:929 W FOOTHILL BLV
Practice Address - Street 2:
Practice Address - City:UPKAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-966-0192
Practice Address - Fax:909-660-1864
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BA20250689869
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty