Provider Demographics
NPI:1093923427
Name:COSSE, CHRISTOPHER C (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:C
Last Name:COSSE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:230 CARROLL ST
Mailing Address - Street 2:STE 1
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4248
Mailing Address - Country:US
Mailing Address - Phone:318-869-1248
Mailing Address - Fax:318-869-1504
Practice Address - Street 1:230 CARROLL ST
Practice Address - Street 2:STE 1
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4248
Practice Address - Country:US
Practice Address - Phone:318-869-1248
Practice Address - Fax:318-869-1504
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA50951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics