Healthcare Provider Details

I. General information

NPI: 1164063004
Provider Name (Legal Business Name): A. OSMA DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44207 20TH ST W
LANCASTER CA
93534-4060
US

IV. Provider business mailing address

37935 47TH ST E STE A22
PALMDALE CA
93552-3268
US

V. Phone/Fax

Practice location:
  • Phone: 661-942-8333
  • Fax:
Mailing address:
  • Phone: 661-350-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AMALIA OSMA
Title or Position: PRESIDENT
Credential:
Phone: 661-350-3344