Provider Demographics
NPI:1396433124
Name:KOSECKI, BRIANNA (DDS)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:KOSECKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 CONRAD RD
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-9216
Mailing Address - Country:US
Mailing Address - Phone:989-324-9706
Mailing Address - Fax:
Practice Address - Street 1:800 S EUCLID AVE STE 4
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-3355
Practice Address - Country:US
Practice Address - Phone:989-686-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901602013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist