Provider Demographics
NPI:1881780237
Name:KOSSOFF, HOWARD ELIOT (DDS)
Entity type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:ELIOT
Last Name:KOSSOFF
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 1:8401 CHAGRIN RD
Mailing Address - Street 2:#12
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4701
Mailing Address - Country:US
Mailing Address - Phone:440-708-0993
Mailing Address - Fax:440-708-0994
Practice Address - Street 1:8401 CHAGRIN RD
Practice Address - Street 2:#12
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4701
Practice Address - Country:US
Practice Address - Phone:440-708-0993
Practice Address - Fax:440-708-0994
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300139081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics