Wyatt Edward Osborne

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11855 Issued in OR

Practice address

150 Market St
Lebanon, OR 97355-2334

Phone

(541) 570-5818

NPI assigned

Jul 12, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wyatt Osborne, DMD, LLC

  • General Practice Dentistry
  • Lebanon, OR
  • NPI 1306790787
  NPD Authorized official

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

{
    "created_epoch": "1689120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1659050268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29186 SANTIAM TERRACE RD",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973559001",
            "telephone_number": "541-570-5818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MARKET ST",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973552334",
            "telephone_number": "541-570-5818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSBORNE",
        "first_name": "WYATT",
        "middle_name": "EDWARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-12",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oregon Sonography LLC
• Kenneth L. Orwick, M.D.
• Kevin E Osborne, DMD
• Orin Levi Osborne, DMD
• Q Leslie Osborne, DMD
• Shelly Rae Ottre, LPC
• Andrew Robert Owenreay, DO
• Lauren Alexandra Ozdowski
• Monica Jean Paden
• James Page, CADC II

• General Practice Dentistry in Lebanon, OR
• Providers in Lebanon, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.