Provider Demographics
NPI:1881671774
Name:COSGROVE, WILLIAM D (DMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:COSGROVE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-981-1721
Mailing Address - Fax:724-981-7025
Practice Address - Street 1:350 SHARON NEW CASTLE RD
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-1576
Practice Address - Country:US
Practice Address - Phone:724-981-1721
Practice Address - Fax:724-981-7025
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029431L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010726330004Medicaid
PA1010726330003Medicaid
PA1010726330005Medicaid
PA1010726330006Medicaid
OH2497516Medicaid
PA1010726330001Medicaid
PA1010726330007Medicaid