Provider Demographics
NPI:1609194760
Name:KOSICKI, KRYSTYNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRYSTYNA
Middle Name:
Last Name:KOSICKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2719
Mailing Address - Country:US
Mailing Address - Phone:914-937-6555
Mailing Address - Fax:914-937-6555
Practice Address - Street 1:99 PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-2719
Practice Address - Country:US
Practice Address - Phone:914-937-6555
Practice Address - Fax:914-937-6555
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0389101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice