Provider Demographics
NPI:1295425700
Name:OSBORN, JACOB SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:SCOTT
Last Name:OSBORN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 ASCHINGER BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-4608
Mailing Address - Country:US
Mailing Address - Phone:937-336-9141
Mailing Address - Fax:
Practice Address - Street 1:120 WALNUT CREEK PIKE
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1048
Practice Address - Country:US
Practice Address - Phone:740-477-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.027145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist