Provider Demographics
NPI:1366508988
Name:COSLETT, KAREN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:L
Last Name:COSLETT
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 1:2901 PARK AVE.
Mailing Address - Street 2:STE. C-1
Mailing Address - City:OQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2831
Mailing Address - Country:US
Mailing Address - Phone:831-476-6900
Mailing Address - Fax:831-476-6917
Practice Address - Street 1:2901 PARK AVE
Practice Address - Street 2:STE. C-1
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2831
Practice Address - Country:US
Practice Address - Phone:831-476-6900
Practice Address - Fax:831-476-6917
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice