MEDICARE: MICHAEL DAVID KOSDON DDS

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	46848	CA
2	122300000X	Dentist	0549844	NY

General Provider Information

NPI Number	:	1003911850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DAVID KOSDON DDS

Provider Business Mailing Address
First Line	:	30 CENTRAL PARK S RM 12D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-1653
Country	:	US
Telephone Number	:	212-658-1440
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 CENTRAL PARK S RM 12D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-1653
Country	:	US
Telephone Number	:	212-658-1440
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	10/12/2022

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