MEDICARE: DR. JOSEPH A KOSZELAK 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	043687	NY

General Provider Information

NPI Number	:	1487822250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH A KOSZELAK DDS

Provider Business Mailing Address
First Line	:	605 DIVISION ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-4486
Country	:	US
Telephone Number	:	716-694-0194
Fax Number	:	716-692-3673

Provider Business Practice Location Address
First Line	:	605 DIVISION ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-4486
Country	:	US
Telephone Number	:	716-694-0194
Fax Number	:	716-692-3673

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

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	09/10/2013

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