Provider Demographics
NPI:1356673198
Name:DAVID E. KOSIOREK, D.M.D. ORTHODONTIST
Entity Type:Organization
Organization Name:DAVID E. KOSIOREK, D.M.D. ORTHODONTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOSIOREK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-567-1300
Mailing Address - Street 1:123 DWIGHT RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 DWIGHT RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1748
Practice Address - Country:US
Practice Address - Phone:413-567-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty