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General NPI Number Information
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NPI Number | 1407646912
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Entity Type | Organization
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Legal Business Name | DENTAL OFFICE DE LA OSA DDS INC
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 929 W FOOTHILL BLVD
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City | UPKAND
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State | CA
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Zip | 91786
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Country | US
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Telephone | 909-966-0192
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Fax | 909-660-1864
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Provider Business Mailing Address
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Address Line | 929 W FOOTHILL BLVD
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City | UPKAND
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State | CA
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Zip | 91786
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Country | US
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Telephone | 909-966-0192
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Fax | 909-660-1864
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Authorized Official
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Title or Position | DDS
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Name | JORGE C DE LA OSA
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Credential |
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Telephone | 909-660-1921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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