Individual
KODY QUENTIN OSBORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1075 S WELLS ST, MERIDIAN, ID 83642-7997
(855) 433-6825
Mailing address
647 W BROADWAY AVE, MERIDIAN, ID 83642-2404
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D11460
OR
1223G0001X
General Practice Dentistry
Primary
D5324
ID
1223G0001X
General Practice Dentistry
DEN-DEN-LIC-21478
MT
Other
Enumeration date
06/27/2021
Last updated
10/27/2021
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