Individual provider Active NPI

Woody L. Osborn, D.M.D.

  • General Practice Dentistry
  • Clinton, MS
National Provider Identifier
1487743746
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2194-85 Issued in MS
Practice address
539B Highway 80 W
Clinton, MS 39056-4193
Phone
(601) 924-4751
Fax
(601) 924-0866
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2194-85 MS Primary

Addresses

Primary practice location

539B Highway 80 W
Clinton, MS 39056-4193

Mailing address

539B Highway 80 W
Clinton, MS 39056-4193
Phone (601) 924-4751

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151014000676 MS Order and Referring Only - DentistPractitioner - Dentist 2961711056

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487743746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "539B HIGHWAY 80 W",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390564193",
            "telephone_number": "601-924-4751",
            "fax_number": "601-924-0866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "539B HIGHWAY 80 W",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390564193",
            "telephone_number": "601-924-4751",
            "fax_number": "601-924-0866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSBORN",
        "first_name": "WOODY",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "2194-85",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, MS

Sources for this page

Verify at the official NPI Registry.