Individual
COLIN PORTER OSBORNE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS,PA
Contact information
Practice address
407 W 27TH ST, LUMBERTON, NC 28358-3019
(910) 738-9396
(910) 738-9395
Mailing address
PO BOX 569, LUMBERTON, NC 28359-0569
(910) 738-9396
(910) 738-9395
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
NC3703
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8996531
—
NC
01
—
96531
BCBSNC
NC
Enumeration date
07/08/2005
Last updated
07/08/2007
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