Provider Demographics
NPI:1578681375
Name:COSSICH, DIMETRY B (DDS)
Entity Type:Individual
Prefix:
First Name:DIMETRY
Middle Name:B
Last Name:COSSICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 MANHATTAN BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-3400
Mailing Address - Country:US
Mailing Address - Phone:504-361-5333
Mailing Address - Fax:504-361-5322
Practice Address - Street 1:1708 MANHATTAN BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-3400
Practice Address - Country:US
Practice Address - Phone:504-361-5333
Practice Address - Fax:504-361-5322
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA42661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice