Provider Demographics
NPI:1013182328
Name:KOSOVEC, MICHAEL JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:KOSOVEC
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 1:2010 EASTWOOD DRIVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704
Mailing Address - Country:US
Mailing Address - Phone:608-241-1579
Mailing Address - Fax:608-241-2061
Practice Address - Street 1:2010 EASTWOOD DR
Practice Address - Street 2:SUITE 206
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5387
Practice Address - Country:US
Practice Address - Phone:608-241-1579
Practice Address - Fax:608-241-2061
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001511-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice