MEDICARE: LAURA COSLET DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22DI01859400	NJ

General Provider Information

NPI Number	:	1003033408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA COSLET DMD

Provider Business Mailing Address
First Line	:	402 WHITE HORSE PIKE S
Second Line	:
City	:	MAGNOLIA
State	:	NJ
Zip	:	08049-1061
Country	:	US
Telephone Number	:	856-566-9700
Fax Number	:	856-566-1689

Provider Business Practice Location Address
First Line	:	402 WHITE HORSE PIKE S
Second Line	:
City	:	MAGNOLIA
State	:	NJ
Zip	:	08049-1061
Country	:	US
Telephone Number	:	856-566-9700
Fax Number	:	856-566-1689

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/08/2007

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Directions to “ LAURA COSLET DMD” Practice Location

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