MEDICARE: INDU KOSURI

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	DS040247	PA

General Provider Information

NPI Number	:	1821495144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDU KOSURI

Provider Business Mailing Address
First Line	:	350 N CLARK ST FL 6
Second Line	:	DENTAL DREAMS LLC
City	:	CHICAGO
State	:	IL
Zip	:	60654-4712
Country	:	US
Telephone Number	:	312-274-4520
Fax Number	:

Provider Business Practice Location Address
First Line	:	3867 UNION DEPOSIT RD
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17109-5920
Country	:	US
Telephone Number	:	717-558-0042
Fax Number	:

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

Provider Enumeration Date	:	12/02/2014
Last Update Date	:	01/23/2015

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Directions to “ INDU KOSURI ” Practice Location

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