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General NPI Number Information
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NPI Number | 1437462777
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Entity Type | Organization
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Legal Business Name | DIMETRY B COSSICH COSMETIC & FAMILY DENTISTRY APDC
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 1708 MANHATTAN BLVD
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City | HARVEY
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State | LA
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Zip | 70058-3400
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Country | US
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Telephone | 504-361-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 1708 MANHATTAN BLVD
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City | HARVEY
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State | LA
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Zip | 70058-3400
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Country | US
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Telephone | 504-361-5333
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIMETRY B COSSICH
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Credential | DDS
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Telephone | 504-361-5333
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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 | 4266
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License Number State | LA
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