Healthcare Provider Details

I. General information

NPI: 1285951996
Provider Name (Legal Business Name): VALERIE M OSBORN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 POTTER VILLAGE RD
CHARLTON MA
01507-6723
US

IV. Provider business mailing address

27 POTTER VILLAGE RD
CHARLTON MA
01507-6723
US

V. Phone/Fax

Practice location:
  • Phone: 617-571-1697
  • Fax:
Mailing address:
  • Phone: 617-571-1697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number13020
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: