=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760638431
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STANLEY KAJ COSS DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2008
-----------------------------------------------------
Last Update Date | 08/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7900 SHIN OAK
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-654-1851
-----------------------------------------------------
Fax | 210-654-3078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7900 SHIN OAK
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-654-1851
-----------------------------------------------------
Fax | 210-654-3078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 10805
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------