Provider Demographics
NPI:1457482168
Name:KOSAKOSKI, EDWARD DWIGHT (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DWIGHT
Last Name:KOSAKOSKI
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 1:12550 6TH STREET EAST
Mailing Address - Street 2:
Mailing Address - City:TREASURE ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33706
Mailing Address - Country:US
Mailing Address - Phone:858-837-1128
Mailing Address - Fax:
Practice Address - Street 1:2515 COUNTRYSIDE BLVD STE A
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1603
Practice Address - Country:US
Practice Address - Phone:727-475-7519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN109331223E0200X
CA361251223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330924971OtherTAX ID