Provider Demographics
NPI:1568666576
Name:COSMET ENTERPRIZE LLC
Entity Type:Organization
Organization Name:COSMET ENTERPRIZE LLC
Other - Org Name:THE DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-408-1400
Mailing Address - Street 1:12344 ROPER BLVD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34771-4300
Mailing Address - Country:US
Mailing Address - Phone:352-242-1763
Mailing Address - Fax:352-242-6376
Practice Address - Street 1:12344 ROPER BLVD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34771-4300
Practice Address - Country:US
Practice Address - Phone:352-242-1763
Practice Address - Fax:352-242-6376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty