Healthcare Provider Details

I. General information

NPI: 1891971776
Provider Name (Legal Business Name): ROGER HOWARD KOSLEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 TAMIAMI TRL N
NAPLES FL
34108-2525
US

IV. Provider business mailing address

8801 TAMIAMI TRL N
NAPLES FL
34108-2525
US

V. Phone/Fax

Practice location:
  • Phone: 239-594-8108
  • Fax: 239-594-7404
Mailing address:
  • Phone: 239-594-8108
  • Fax: 239-594-7404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN13329
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN13329
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: