Provider Demographics
NPI:1568430114
Name:KONOSKE, MARIE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:KONOSKE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 DEMBOSKI RD
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935-8512
Mailing Address - Country:US
Mailing Address - Phone:906-265-3416
Mailing Address - Fax:
Practice Address - Street 1:211 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL FALLS
Practice Address - State:MI
Practice Address - Zip Code:49920-1503
Practice Address - Country:US
Practice Address - Phone:906-875-6133
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902010252124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist