Provider Demographics
NPI:1346090065
Name:CRYSTAL COAST COSMETIC CARE ENT SURGICAL SERVICES
Entity Type:Organization
Organization Name:CRYSTAL COAST COSMETIC CARE ENT SURGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLLC BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:ROSKA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:252-503-8707
Mailing Address - Street 1:101 HOPE TOWN CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28584-4501
Mailing Address - Country:US
Mailing Address - Phone:252-503-8707
Mailing Address - Fax:
Practice Address - Street 1:231 WB MCLEAN DR
Practice Address - Street 2:
Practice Address - City:CAPE CARTERET
Practice Address - State:NC
Practice Address - Zip Code:28584-8515
Practice Address - Country:US
Practice Address - Phone:252-764-5414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Multi-Specialty
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Multi-Specialty
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty