Provider Demographics
NPI:1104827187
Name:KOSMALSKI, RUTH G (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:G
Last Name:KOSMALSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4355 RIORDAN HILL DR
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-8702
Mailing Address - Country:US
Mailing Address - Phone:541-386-2612
Mailing Address - Fax:541-386-2164
Practice Address - Street 1:1835 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1657
Practice Address - Country:US
Practice Address - Phone:541-386-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist