Provider Demographics
NPI:1639536840
Name:CLE ORAL & MAXILLOFACIAL SURGERY WESTLAKE - JEFFREY W. KOSMAN, D.D.S.,
Entity Type:Organization
Organization Name:CLE ORAL & MAXILLOFACIAL SURGERY WESTLAKE - JEFFREY W. KOSMAN, D.D.S.,
Other - Org Name:CLE ORAL & MAXILLOFACIAL SURGERY WESTLAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:KOSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-934-2626
Mailing Address - Street 1:28871 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5271
Mailing Address - Country:US
Mailing Address - Phone:440-871-2201
Mailing Address - Fax:440-871-2204
Practice Address - Street 1:28871 CENTER RIDGE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5271
Practice Address - Country:US
Practice Address - Phone:440-871-2201
Practice Address - Fax:440-871-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175161223S0112X
OH300243941223S0112X
OH300202211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty