Healthcare Provider Details

I. General information

NPI: 1346530045
Provider Name (Legal Business Name): DEBORAH KAYE OSBORN RDA, RDH, RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 11/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 GHETTIS WAY
RENO NV
89521-5032
US

IV. Provider business mailing address

PO BOX 17094
RENO NV
89511-2870
US

V. Phone/Fax

Practice location:
  • Phone: 775-851-6018
  • Fax: 775-851-6013
Mailing address:
  • Phone: 775-851-6018
  • Fax: 775-851-6013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number22249
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number101046
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number05238
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2079
License Number StateAK
# 5
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: