Provider Demographics
NPI:1710365770
Name:JAMES KOSYDAR DDS PA
Entity type:Organization
Organization Name:JAMES KOSYDAR DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOSYDAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-522-9192
Mailing Address - Street 1:5200 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-2612
Mailing Address - Country:US
Mailing Address - Phone:727-522-9192
Mailing Address - Fax:727-522-5898
Practice Address - Street 1:5200 16TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-2612
Practice Address - Country:US
Practice Address - Phone:727-522-9192
Practice Address - Fax:727-522-5898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty