Healthcare Provider Details

I. General information

NPI: 1689663312
Provider Name (Legal Business Name): DAVID LAWRENCE KOSS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 FIELDSTONE DR
HARTSDALE NY
10530-1564
US

IV. Provider business mailing address

99 FIELDSTONE DR
HARTSDALE NY
10530-1564
US

V. Phone/Fax

Practice location:
  • Phone: 914-997-8820
  • Fax: 914-997-9627
Mailing address:
  • Phone: 914-997-8820
  • Fax: 914-997-9627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0033555
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: