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General NPI Number Information
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NPI Number | 1306109475
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Entity Type | Individual
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Provider Name | ZENON PAUL KOSSAK DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 300 E LONG LAKE RD STE 290
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48304-2378
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Country | US
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Telephone | 248-203-2330
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Fax |
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Provider Business Mailing Address
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Address Line | 300 E LONG LAKE RD STE 290
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48304-2378
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Country | US
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Telephone | 248-203-2330
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN23273
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2901020635
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License Number State | MI
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