Provider Demographics
NPI:1437416849
Name:COSLETT, RICHARD G (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:COSLETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S. MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708
Mailing Address - Country:US
Mailing Address - Phone:570-696-3868
Mailing Address - Fax:570-696-3541
Practice Address - Street 1:121 S. MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:SHAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18708
Practice Address - Country:US
Practice Address - Phone:570-696-3868
Practice Address - Fax:570-696-3541
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-024193-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist