Provider Demographics
NPI:1497134563
Name:KOSIK, STEPHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:KOSIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 MONROE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1981
Mailing Address - Country:US
Mailing Address - Phone:419-475-0482
Mailing Address - Fax:419-474-0017
Practice Address - Street 1:4333 MONROE ST
Practice Address - Street 2:SUITE B
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1981
Practice Address - Country:US
Practice Address - Phone:419-475-0482
Practice Address - Fax:419-474-0017
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.24860122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist