Healthcare Provider Details

I. General information

NPI: 1275334344
Provider Name (Legal Business Name): OSAHON NELSON IGBINOBA DMD,BDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 ALBANY ST
BOSTON MA
02118-3550
US

IV. Provider business mailing address

3882 S CLACK ST
ABILENE TX
79606-2711
US

V. Phone/Fax

Practice location:
  • Phone: 617-358-8300
  • Fax:
Mailing address:
  • Phone: 325-695-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41992
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: