Provider Demographics
NPI:1063491710
Name:KOSLICA, CRAIG J (DDS)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:J
Last Name:KOSLICA
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 1:1250 PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-2041
Mailing Address - Country:US
Mailing Address - Phone:608-643-8505
Mailing Address - Fax:608-643-8097
Practice Address - Street 1:240 W. JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588
Practice Address - Country:US
Practice Address - Phone:608-588-2122
Practice Address - Fax:608-588-5192
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4351-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice