Provider Demographics
NPI:1518010669
Name:KOSER, EWA P (DDS)
Entity Type:Individual
Prefix:DR
First Name:EWA
Middle Name:P
Last Name:KOSER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W KENSINGTON RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1293
Mailing Address - Country:US
Mailing Address - Phone:847-577-5464
Mailing Address - Fax:847-577-5474
Practice Address - Street 1:250 W KENSINGTON RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1293
Practice Address - Country:US
Practice Address - Phone:847-577-5464
Practice Address - Fax:847-577-5474
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190242941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice