Provider Demographics
NPI:1669647608
Name:KOSKI& DEPAUL DENTAL GROUP
Entity Type:Organization
Organization Name:KOSKI& DEPAUL DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:440-461-9600
Mailing Address - Street 1:5564 WILSON MILLS RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3265
Mailing Address - Country:US
Mailing Address - Phone:440-461-9600
Mailing Address - Fax:440-461-4035
Practice Address - Street 1:5564 WILSON MILLS RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-3265
Practice Address - Country:US
Practice Address - Phone:440-461-9600
Practice Address - Fax:440-461-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002186861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty