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General NPI Number Information
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NPI Number | 1306790787
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Entity Type | Organization
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Legal Business Name | WYATT OSBORNE, DMD, LLC
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Dates
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Enumeration Date | 02/23/2026
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 21 CASCADE DR
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City | LEBANON
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State | OR
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Zip | 97355-3765
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Country | US
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Telephone | 541-570-5818
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Fax |
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Provider Business Mailing Address
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Address Line | 29186 SANTIAM TERRACE RD
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City | LEBANON
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State | OR
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Zip | 97355-9001
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Country | US
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Telephone | 541-570-5818
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | WYATT OSBORNE
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Credential | DMD
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Telephone | 541-570-5818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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