Provider Demographics
NPI:1770565921
Name:KOSMITIS, KIM (DDS)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:KOSMITIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 W 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7003
Mailing Address - Country:US
Mailing Address - Phone:870-535-1115
Mailing Address - Fax:870-535-3222
Practice Address - Street 1:1406 W 42ND AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7003
Practice Address - Country:US
Practice Address - Phone:870-535-1115
Practice Address - Fax:870-535-3222
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice