Provider Demographics
NPI:1063507069
Name:KOSOSKI, JOSEPH ANTHONY (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:KOSOSKI
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 1:400 MAPLELAWN DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-5744
Mailing Address - Country:US
Mailing Address - Phone:972-235-8900
Mailing Address - Fax:469-453-3009
Practice Address - Street 1:400 MAPLELAWN DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-5744
Practice Address - Country:US
Practice Address - Phone:972-235-8900
Practice Address - Fax:469-453-3009
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice