Provider Demographics
NPI:1891971776
Name:KOSLEN, ROGER HOWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:HOWARD
Last Name:KOSLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8801 TAMIAMI TRL N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2525
Mailing Address - Country:US
Mailing Address - Phone:239-594-8108
Mailing Address - Fax:239-594-7404
Practice Address - Street 1:8801 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2525
Practice Address - Country:US
Practice Address - Phone:239-594-8108
Practice Address - Fax:239-594-7404
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN133291223P0700X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics