Provider Demographics
NPI:1902548571
Name:KOSILESKI, KATELYN ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:ELIZABETH
Last Name:KOSILESKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:ELIZABETH
Other - Last Name:JAKYMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27748 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-3919
Mailing Address - Country:US
Mailing Address - Phone:440-835-2121
Mailing Address - Fax:
Practice Address - Street 1:27748 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-3919
Practice Address - Country:US
Practice Address - Phone:440-835-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2951000887122300000X
390200000X
OH30.026878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program