Provider Demographics
NPI:1801380324
Name:KOSKI, KYLE D (DMD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:D
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 1:850 BRAINARD RD STE 3
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3145
Mailing Address - Country:US
Mailing Address - Phone:440-829-4290
Mailing Address - Fax:
Practice Address - Street 1:850 BRAINARD RD STE 3
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-3145
Practice Address - Country:US
Practice Address - Phone:440-829-4290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0254911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30.025491OtherENTITY TYPE 1 (DENTIST)