Provider Demographics
NPI:1912292038
Name:JIM COSSAART DDS
Entity Type:Organization
Organization Name:JIM COSSAART DDS
Other - Org Name:HEBRON DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:COSSAART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-768-7252
Mailing Address - Street 1:124 N 5TH ST
Mailing Address - Street 2:PO BOX 76
Mailing Address - City:HEBRON
Mailing Address - State:NE
Mailing Address - Zip Code:68370-1512
Mailing Address - Country:US
Mailing Address - Phone:402-768-7252
Mailing Address - Fax:402-768-7258
Practice Address - Street 1:124 N 5TH ST
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:NE
Practice Address - Zip Code:68370-1512
Practice Address - Country:US
Practice Address - Phone:402-768-7252
Practice Address - Fax:402-768-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE67451223G0001X
NE49451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty