Healthcare Provider Details

I. General information

NPI: 1497901482
Provider Name (Legal Business Name): ROBERT G COSEO DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 CAMP ST
HYANNIS MA
02601
US

IV. Provider business mailing address

65 CAMP ST
HYANNIS MA
02601
US

V. Phone/Fax

Practice location:
  • Phone: 508-775-9977
  • Fax: 508-775-9976
Mailing address:
  • Phone: 508-775-9977
  • Fax: 508-775-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12732
License Number StateMA

VIII. Authorized Official

Name: DR. ROBERT G COSEO
Title or Position: PRESIDENT
Credential: DDS
Phone: 508-775-9977