Provider Demographics
NPI:1497512263
Name:JESSY KOSHY BDS DMD PC
Entity Type:Organization
Organization Name:JESSY KOSHY BDS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-993-7947
Mailing Address - Street 1:7878 ROSWELL RD STE O
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4866
Mailing Address - Country:US
Mailing Address - Phone:770-993-7947
Mailing Address - Fax:770-993-8079
Practice Address - Street 1:7878 ROSWELL RD STE O
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-4866
Practice Address - Country:US
Practice Address - Phone:770-993-7947
Practice Address - Fax:770-993-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty