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General NPI Number Information
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NPI Number | 1114164811
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Entity Type | Organization
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Legal Business Name | LORRAINE KOSZTYU, D.M.D.
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Dates
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Enumeration Date | 01/16/2009
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 82 FRANKLIN CORNER RD
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2102
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Country | US
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Telephone | 609-896-1050
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Fax | 609-896-1618
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Provider Business Mailing Address
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Address Line | 82 FRANKLIN CORNER RD
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2102
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Country | US
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Telephone | 609-896-1050
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Fax | 609-896-1618
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LORRAINE KOSZTYU
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Credential | D.M.D.
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Telephone | 609-896-1050
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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 | 22DI01965300
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License Number State | NJ
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