Provider Demographics
NPI:1295944866
Name:KOSARIN, PAUL A (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:KOSARIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:A
Other - Last Name:KOSARIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1228 WANTAGH AVE
Mailing Address - Street 2:202
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2209
Mailing Address - Country:US
Mailing Address - Phone:516-785-0730
Mailing Address - Fax:516-785-0298
Practice Address - Street 1:1228 WANTAGH AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2209
Practice Address - Country:US
Practice Address - Phone:516-785-0730
Practice Address - Fax:516-785-0298
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112236923OtherDENTAL