Kody Quentin Osborne, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D5324 Issued in ID

Practice address

1075 S Wells St
Meridian, ID 83642-7997

Phone

(855) 433-6825

NPI assigned

Jun 27, 2021

Last updated

Oct 27, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Santiam Dental Group, LLC

  dba Osborne Dentistry Registry #1356504-97

  • General Practice Dentistry
  • Lebanon, OR
  • NPI 1003898073
  NPD (past)

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

{
    "created_epoch": "1624752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1770153314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "647 W BROADWAY AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 S WELLS ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427997",
            "telephone_number": "855-433-6825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 Market St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "OR",
            "postal_code": "973552334",
            "country_code": "US",
            "telephone_number": "541-451-4300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OSBORNE",
        "first_name": "KODY",
        "middle_name": "QUENTIN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-27",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MT",
            "license": "DEN-DEN-LIC-21478",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11460",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D5324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Ormsby, MS, CF-SLP
• Sarah Wampold Orr
• Orthopaedic Trauma Consultants of Idaho (North Fork Orthopedic Surgery)
• Orthopedic Health Care Incorporated
• Sara Orton
• Osteoarthritis Centers of America Medical Group PC (OsteoArthritis Centers of America)
• Jan Osterberg
• Mariya Rose Ostermiller, MPAS, PA-C
• Sis E Ostolasa, PA
• Marivin Oto, DDS

• General Practice Dentistry in Meridian, ID
• Providers in Meridian, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.