Provider Demographics
NPI:1962619684
Name:OSBORN, TIMOTHY MARX (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MARX
Last Name:OSBORN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 MIDDLESEX AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5056
Mailing Address - Country:US
Mailing Address - Phone:617-447-3980
Mailing Address - Fax:
Practice Address - Street 1:287 MIDDLESEX AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5056
Practice Address - Country:US
Practice Address - Phone:617-286-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8485122300000X
MA243648204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist