Provider Demographics
NPI:1639201197
Name:KOSHLAND, STEPHEN BERNAT (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BERNAT
Last Name:KOSHLAND
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 1:7301 MISSION RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3031
Mailing Address - Country:US
Mailing Address - Phone:913-722-6611
Mailing Address - Fax:
Practice Address - Street 1:7301 MISSION RD STE 200
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3031
Practice Address - Country:US
Practice Address - Phone:913-722-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist