Provider Demographics
NPI:1609035534
Name:LANCE OSBORNE DDS, PA
Entity type:Organization
Organization Name:LANCE OSBORNE DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-442-4051
Mailing Address - Street 1:245 W VAN ASCHE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4973
Mailing Address - Country:US
Mailing Address - Phone:479-442-4051
Mailing Address - Fax:479-442-5907
Practice Address - Street 1:245 W VAN ASCHE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4973
Practice Address - Country:US
Practice Address - Phone:479-442-4051
Practice Address - Fax:479-442-5907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty