Provider Demographics
NPI:1235917659
Name:CHRISTOPHER COSSE, DDS, L.L.C.
Entity type:Organization
Organization Name:CHRISTOPHER COSSE, DDS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-283-8867
Mailing Address - Street 1:5300 PATTERSON AVE SE STE 110
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9758
Mailing Address - Country:US
Mailing Address - Phone:616-283-8867
Mailing Address - Fax:
Practice Address - Street 1:230 CARROLL ST STE 1
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4248
Practice Address - Country:US
Practice Address - Phone:318-532-4719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTOPHER COSSE, DDS, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty