Healthcare Provider Details

I. General information

NPI: 1164574786
Provider Name (Legal Business Name): GREGORY A. OSBORNE DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 OAKWELL CT STE 102B
SAN ANTONIO TX
78218-3075
US

IV. Provider business mailing address

3301 OAKWELL CT STE 102B
SAN ANTONIO TX
78218-3075
US

V. Phone/Fax

Practice location:
  • Phone: 210-202-0692
  • Fax: 210-338-8747
Mailing address:
  • Phone: 210-202-0692
  • Fax: 210-338-8747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY ALLEN OSBORNE
Title or Position: PRESIDENT
Credential: DDS
Phone: 210-202-0692