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Organization
SELECT DENTAL ASSOCIATES PC
Active
Organization
SELECT DENTAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS J KOSEK DDS (OWNER)
(574) 340-3423
Entity
Organization
Contact information
Practice address
1422 LINCOLN WAY E, SOUTH BEND, IN 46613-3250
(574) 232-8888
(574) 232-8929
Mailing address
1422 LINCOLN WAY E, SOUTH BEND, IN 46613-3250
(574) 232-8888
(574) 232-8929
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009873
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12010354A
STATE LICENSE
IN
01
—
12012866A
STATE LICENSE
IN
05
—
200214390
—
IN
Enumeration date
02/02/2018
Last updated
02/02/2018
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