MEDICARE: EUGENIA OSBON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2023022202	MO
2	1223G0001X	General Practice Dentistry	D012308	AZ

General Provider Information

NPI Number	:	1447950654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENIA OSBON

Provider Business Mailing Address
First Line	:	371 LAKE HAVASU AVE S
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-9307
Country	:	US
Telephone Number	:	928-855-8333
Fax Number	:

Provider Business Practice Location Address
First Line	:	371 LAKE HAVASU AVE S
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-9307
Country	:	US
Telephone Number	:	928-855-8333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	08/28/2024

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Directions to “ EUGENIA OSBON ” Practice Location

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