Healthcare Provider Details

I. General information

NPI: 1356673198
Provider Name (Legal Business Name): DAVID E. KOSIOREK, D.M.D. ORTHODONTIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 DWIGHT RD SUITE 4
LONGMEADOW MA
01106-1748
US

IV. Provider business mailing address

123 DWIGHT RD SUITE 4
LONGMEADOW MA
01106-1748
US

V. Phone/Fax

Practice location:
  • Phone: 413-567-1300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number15133
License Number StateMA

VIII. Authorized Official

Name: MR. DAVID E. KOSIOREK
Title or Position: DOCTOR
Credential: DMD
Phone: 413-567-1300