Provider Demographics
NPI:1467675470
Name:KOSOFSKY, RICHARD A (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:KOSOFSKY
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 1:2 DAYTON DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3409
Mailing Address - Country:US
Mailing Address - Phone:732-549-0002
Mailing Address - Fax:
Practice Address - Street 1:2 DAYTON DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3409
Practice Address - Country:US
Practice Address - Phone:732-549-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI010840001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice