Provider Demographics
NPI:1003995390
Name:KOSHY, JESSY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSY
Middle Name:
Last Name:KOSHY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8613 ROSWELL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-1887
Mailing Address - Country:US
Mailing Address - Phone:770-993-7947
Mailing Address - Fax:770-993-8079
Practice Address - Street 1:8613 ROSWELL RD STE 101
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-1887
Practice Address - Country:US
Practice Address - Phone:770-993-7947
Practice Address - Fax:770-993-8079
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO12589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist