Provider Demographics
NPI:1396768735
Name:JEFF KOSORIS D.D.S., INC.
Entity type:Organization
Organization Name:JEFF KOSORIS D.D.S., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KOSORIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-938-1845
Mailing Address - Street 1:131 MARK TRL
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1359
Mailing Address - Country:US
Mailing Address - Phone:972-938-1845
Mailing Address - Fax:972-938-7718
Practice Address - Street 1:131 MARK TRL
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1359
Practice Address - Country:US
Practice Address - Phone:972-938-1845
Practice Address - Fax:972-938-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty