Provider Demographics
NPI:1831309343
Name:KOKOSKA, CHARLES MARTIN JR (DO)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MARTIN
Last Name:KOKOSKA
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:161 WATERDAM RD APT 250
Mailing Address - Street 2:
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2572
Mailing Address - Country:US
Mailing Address - Phone:724-942-3820
Mailing Address - Fax:724-942-5810
Practice Address - Street 1:161 WATERDAM RD APT 250
Practice Address - Street 2:
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2572
Practice Address - Country:US
Practice Address - Phone:724-942-3820
Practice Address - Fax:724-942-5810
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027496L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist