Provider Demographics
NPI:1063506285
Name:KOSHY, MIRIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
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 1:11653 N WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-5890
Mailing Address - Country:US
Mailing Address - Phone:352-489-8433
Mailing Address - Fax:352-489-8477
Practice Address - Street 1:11653 N WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-5890
Practice Address - Country:US
Practice Address - Phone:352-489-8433
Practice Address - Fax:352-489-8477
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN158701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice