Provider Demographics
NPI:1043487820
Name:KOSLOVSKY, DAVID A (DDS, FACS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:KOSLOVSKY
Suffix:
Gender:M
Credentials:DDS, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800B 5TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7277
Mailing Address - Country:US
Mailing Address - Phone:646-734-3929
Mailing Address - Fax:212-888-4710
Practice Address - Street 1:800B 5TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7277
Practice Address - Country:US
Practice Address - Phone:212-888-4760
Practice Address - Fax:212-888-4710
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0549541223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03257903Medicaid