Healthcare Provider Details

I. General information

NPI: 1710558010
Provider Name (Legal Business Name): RYAN DEAN KOSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8721 TURNPIKE DR
WESTMINSTER CO
80031-7046
US

IV. Provider business mailing address

3121 YATES ST
DENVER CO
80212-1651
US

V. Phone/Fax

Practice location:
  • Phone: 303-657-9000
  • Fax:
Mailing address:
  • Phone: 406-544-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number00204759
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: