Provider Demographics
NPI:1033126800
Name:KOSHETAR, JOYCE ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:ELIZABETH
Last Name:KOSHETAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 HOLMES ROAD
Mailing Address - Street 2:
Mailing Address - City:HOLMES
Mailing Address - State:PA
Mailing Address - Zip Code:19043-1215
Mailing Address - Country:US
Mailing Address - Phone:610-522-1741
Mailing Address - Fax:610-522-0474
Practice Address - Street 1:363 HOLMES ROAD
Practice Address - Street 2:
Practice Address - City:HOLMES
Practice Address - State:PA
Practice Address - Zip Code:19043-1215
Practice Address - Country:US
Practice Address - Phone:610-522-1741
Practice Address - Fax:610-522-0474
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021956L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice