Provider Demographics
NPI:1760712079
Name:KOSTEN DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:KOSTEN DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KOSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-345-6363
Mailing Address - Street 1:500 SAINT LOUIS RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-2437
Mailing Address - Country:US
Mailing Address - Phone:618-345-6363
Mailing Address - Fax:
Practice Address - Street 1:500 SAINT LOUIS RD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-2437
Practice Address - Country:US
Practice Address - Phone:618-345-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty