# SELECT DENTAL ASSOCIATES PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457850687
- **Authorized official:** DOUGLAS J KOSEK DDS (OWNER)
- **Authorized official phone:** (574) 340-3423

## Contact information

- **Practice address:** 1422 LINCOLN WAY E, SOUTH BEND, IN 46613-3250
- **Practice address phone:** (574) 232-8888
- **Practice address fax:** (574) 232-8929
- **Mailing address:** 1422 LINCOLN WAY E, SOUTH BEND, IN 46613-3250
- **Mailing address phone:** (574) 232-8888
- **Mailing address fax:** (574) 232-8929

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12009873 | IN | Yes |

## Other

- **Enumeration date:** 02/02/2018
- **Last updated:** 02/02/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 12010354A | STATE LICENSE | IN |
| 01 | — | 12012866A | STATE LICENSE | IN |
| 05 | — | 200214390 | — | IN |