Healthcare Provider Details

I. General information

NPI: 1649853920
Provider Name (Legal Business Name): STEVEN ANDREW COSGROVE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 ANTHONY DR
ANTHONY NM
88021-9325
US

IV. Provider business mailing address

855 ANTHONY DR
ANTHONY NM
88021-9325
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-3607
  • Fax:
Mailing address:
  • Phone: 575-882-3607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13347
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: