Provider Demographics
NPI:1598822702
Name:COSGROVE, BYRON P I (DDS)
Entity Type:Individual
Prefix:MR
First Name:BYRON
Middle Name:P
Last Name:COSGROVE
Suffix:I
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 1:9850 N MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-1901
Mailing Address - Country:US
Mailing Address - Phone:619-448-6113
Mailing Address - Fax:619-448-6191
Practice Address - Street 1:9850 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-1901
Practice Address - Country:US
Practice Address - Phone:619-448-6113
Practice Address - Fax:619-448-6191
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice