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General NPI Number Information
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NPI Number | 1104067669
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Entity Type | Organization
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Legal Business Name | GREGORY P KOSMIDIS DMD PC
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Dates
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Enumeration Date | 03/13/2009
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Last Update Date | 03/13/2009
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Provider Practice Location Address
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Address Line | 10 ROGERS ST 1C
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City | CAMBRIDGE
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State | MA
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Zip | 02142-1246
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Country | US
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Telephone | 617-497-6453
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Fax | 617-497-0003
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Provider Business Mailing Address
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Address Line | 10 ROGERS ST 1C
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City | CAMBRIDGE
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State | MA
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Zip | 02142-1246
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Country | US
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Telephone | 617-497-6453
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Fax | 617-497-0003
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY P KOSMIDIS
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Credential | DMD
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Telephone | 617-497-6453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 21156
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License Number State | MA
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