Healthcare Provider Details

I. General information

NPI: 1871805705
Provider Name (Legal Business Name): KEVIN CHRISTOPHER KOSCSO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0436
US

IV. Provider business mailing address

1622 SW 16TH ST
GAINESVILLE FL
32608-1159
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5440
  • Fax:
Mailing address:
  • Phone: 813-610-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN19000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: