Provider Demographics
NPI:1982734927
Name:ALAN J. KOSSMAN, D.D.S., P.C.
Entity Type:Organization
Organization Name:ALAN J. KOSSMAN, D.D.S., P.C.
Other - Org Name:BELVIDERE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-544-3111
Mailing Address - Street 1:1935 N STATE ST
Mailing Address - Street 2:P O BOX 637
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-1948
Mailing Address - Country:US
Mailing Address - Phone:815-544-3111
Mailing Address - Fax:815-547-4569
Practice Address - Street 1:1935 N STATE ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-1948
Practice Address - Country:US
Practice Address - Phone:815-544-3111
Practice Address - Fax:815-547-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190230381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty