Provider Demographics
NPI:1760822373
Name:KOSKI, JOHN HENRIK (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRIK
Last Name:KOSKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-0157
Mailing Address - Country:US
Mailing Address - Phone:360-687-5665
Mailing Address - Fax:360-687-5053
Practice Address - Street 1:15 SW 20TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-3133
Practice Address - Country:US
Practice Address - Phone:360-687-5665
Practice Address - Fax:360-687-5053
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4341223G0001X
WADE604686401223G0001X
SDD10311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice