Provider Demographics
NPI:1922147073
Name:KOSMAC, TERESA NMN (DMD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:NMN
Last Name:KOSMAC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:KOSMAC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:3111 G ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503
Mailing Address - Country:US
Mailing Address - Phone:707-443-6234
Mailing Address - Fax:707-443-3956
Practice Address - Street 1:3111 G ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503
Practice Address - Country:US
Practice Address - Phone:707-443-6234
Practice Address - Fax:707-443-3956
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist