Provider Demographics
NPI:1205424462
Name:GHADERI KOSZEGHY PERIODONTAL PARTNERSHIP
Entity type:Organization
Organization Name:GHADERI KOSZEGHY PERIODONTAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDGREN-KOSZEGHY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MMSC
Authorized Official - Phone:650-326-1400
Mailing Address - Street 1:850 MIDDLEFIELD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2918
Mailing Address - Country:US
Mailing Address - Phone:650-326-1400
Mailing Address - Fax:
Practice Address - Street 1:850 MIDDLEFIELD RD STE 1
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2918
Practice Address - Country:US
Practice Address - Phone:650-326-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty