Provider Demographics
NPI:1215018056
Name:HOSAGE, JOHN ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:HOSAGE
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 1:335 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5819
Mailing Address - Country:US
Mailing Address - Phone:570-283-1750
Mailing Address - Fax:570-283-1752
Practice Address - Street 1:335 3RD AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5819
Practice Address - Country:US
Practice Address - Phone:570-283-1750
Practice Address - Fax:570-283-1752
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 016013 L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005229270004Medicaid
PA0005229270002Medicaid