Provider Demographics
NPI:1619967262
Name:KOSIOREK, DAVID E (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:KOSIOREK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 DWIGHT RD
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1748
Mailing Address - Country:US
Mailing Address - Phone:413-567-1300
Mailing Address - Fax:413-525-3745
Practice Address - Street 1:123 DWIGHT RD
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1748
Practice Address - Country:US
Practice Address - Phone:413-567-1300
Practice Address - Fax:413-525-3745
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics