Provider Demographics
NPI:1689663312
Name:KOSS, DAVID LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:KOSS
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:99 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1564
Mailing Address - Country:US
Mailing Address - Phone:914-997-8820
Mailing Address - Fax:914-997-9627
Practice Address - Street 1:99 FIELDSTONE DR
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1564
Practice Address - Country:US
Practice Address - Phone:914-997-8820
Practice Address - Fax:914-997-9627
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY00335551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00507671Medicaid