Provider Demographics
NPI:1477621845
Name:COSBY, MICHAEL P (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:COSBY
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 ADAMS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5222
Mailing Address - Country:US
Mailing Address - Phone:303-321-0333
Mailing Address - Fax:303-393-0617
Practice Address - Street 1:180 ADAMS ST STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5222
Practice Address - Country:US
Practice Address - Phone:303-321-0333
Practice Address - Fax:303-393-0617
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7791223S0112X
CO20353174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38537575Medicaid
COD23767Medicare UPIN
CO38537575Medicaid