Provider Demographics
NPI:1437462777
Name:DIMETRY B COSSICH COSMETIC & FAMILY DENTISTRY APDC
Entity Type:Organization
Organization Name:DIMETRY B COSSICH COSMETIC & FAMILY DENTISTRY APDC
Other - Org Name:TODAY'S DENTAL COSMETIC & FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIMETRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:COSSICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-361-5333
Mailing Address - Street 1:1708 MANHATTAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-3400
Mailing Address - Country:US
Mailing Address - Phone:504-361-5333
Mailing Address - Fax:
Practice Address - Street 1:1708 MANHATTAN BLVD
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-3400
Practice Address - Country:US
Practice Address - Phone:504-361-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA42661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty