Healthcare Provider Details

I. General information

NPI: 1003880709
Provider Name (Legal Business Name): JAMES W OSBORNE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10760 E 350 HWY
RAYTOWN MO
64138-1815
US

IV. Provider business mailing address

222 N WINNEBAGO DR
LAKE WINNEBAGO MO
64034-9319
US

V. Phone/Fax

Practice location:
  • Phone: 816-358-9691
  • Fax: 816-358-5116
Mailing address:
  • Phone: 816-847-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number011806
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: