Provider Demographics
NPI:1093066581
Name:DR KOSLOVSKY DDS PC
Entity Type:Organization
Organization Name:DR KOSLOVSKY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSLOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, FACS
Authorized Official - Phone:646-734-3929
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0549541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty