Individual
DR. STEPHEN JAMES COSENTINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1215 DOCTORS DRIVE, TYLER, TX 75701
(903) 592-8152
(903) 592-7583
Mailing address
1215 DOCTORS DRIVE, TYLER, TX 75701
(903) 592-8152
(903) 592-7583
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
15026
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126700702
—
TX
05
—
126700705
—
TX
01
—
865734
UNITED CONCORDIA
—
Enumeration date
11/22/2006
Last updated
07/15/2010
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