Provider Demographics
NPI:1497287932
Name:COSNAHAN, ROBERT JR
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:COSNAHAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 HOFF ST BLDG 9240
Mailing Address - Street 2:USA DENTAL HEALTH ACTIVITY
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905-5645
Mailing Address - Country:US
Mailing Address - Phone:706-544-3103
Mailing Address - Fax:706-544-1933
Practice Address - Street 1:7101 HOFF ST BLDG 9240
Practice Address - Street 2:USA DENTAL HEALTH ACTIVITY
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-5645
Practice Address - Country:US
Practice Address - Phone:706-544-3103
Practice Address - Fax:706-544-1933
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008262122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist