Provider Demographics
NPI:1568645240
Name:KOSMIDIS, GREGORY P (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:KOSMIDIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ROGERS ST
Mailing Address - Street 2:1C
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1246
Mailing Address - Country:US
Mailing Address - Phone:617-497-6453
Mailing Address - Fax:617-497-0003
Practice Address - Street 1:10 ROGERS ST
Practice Address - Street 2:1C
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1246
Practice Address - Country:US
Practice Address - Phone:617-497-6453
Practice Address - Fax:617-497-0003
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA211561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice