Provider Demographics
NPI:1427212505
Name:KOSSMAN, ALAN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:J
Last Name:KOSSMAN
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 1:916 BELVIDERE RD
Mailing Address - Street 2:P O BOX 637
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-9360
Mailing Address - Country:US
Mailing Address - Phone:815-544-3111
Mailing Address - Fax:815-547-4569
Practice Address - Street 1:916 BELVIDERE RD
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-9360
Practice Address - Country:US
Practice Address - Phone:815-544-3111
Practice Address - Fax:815-547-4569
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190230381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice