Provider Demographics
NPI:1083830095
Name:KASIMATIS, KOSMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:KOSMAS
Middle Name:
Last Name:KASIMATIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 EMERSON RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1616
Mailing Address - Country:US
Mailing Address - Phone:908-510-3080
Mailing Address - Fax:732-828-7729
Practice Address - Street 1:900 EASTON AVE STE 31
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1760
Practice Address - Country:US
Practice Address - Phone:732-247-7417
Practice Address - Fax:732-828-7729
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI203051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice