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General NPI Number Information
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NPI Number | 1093066169
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Entity Type | Organization
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Legal Business Name | TREASURE COAST ENDODONTICS
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 900 SE OCEAN BLVD STE B110
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City | STUART
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State | FL
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Zip | 34994-3503
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Country | US
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Telephone | 858-837-1128
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Fax | 858-755-4787
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Provider Business Mailing Address
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Address Line | 900 SE OCEAN BLVD STE B110
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City | STUART
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State | FL
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Zip | 34994-3503
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Country | US
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Telephone | 858-837-1128
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Fax | 858-755-4787
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD D. KOSAKOSKI
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Credential | DMD
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Telephone | 858-837-1128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN 10933
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License Number State | FL
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