Individual
DR. GARY S KODISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
301 SE 16TH ST, FORT LAUDERDALE, FL 33316-2505
(954) 462-5252
(954) 462-5145
Mailing address
301 SE 16TH ST, FORT LAUDERDALE, FL 33316-2505
(954) 462-5252
(954) 462-5145
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8205
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
592018927
FED TAX ID
FL
Enumeration date
04/06/2007
Last updated
07/08/2007
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