Healthcare Provider Details

I. General information

NPI: 1427113240
Provider Name (Legal Business Name): MARY VIRGINIA OSENBAUGH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 ANTELOPE CREEK RD SUITE 140
LINCOLN NE
68506-5592
US

IV. Provider business mailing address

4630 ANTELOPE CREEK RD SUITE 140
LINCOLN NE
68506-5592
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-7432
  • Fax:
Mailing address:
  • Phone: 402-489-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5077
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: