Edward Dwight Kosakoski, D.M.D

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

36125 Issued in CA

Practice address

2515 Countryside Blvd Ste a
Clearwater, FL 33763-1603

Phone

(727) 475-7519

NPI assigned

Mar 7, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Justin N Naylor DDS Professional Dental Corp

  • Endodontics
  • San Diego, CA
  • NPI 1093554677
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1457482168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12550 6TH STREET EAST",
            "city": "TREASURE ISLAND",
            "state": "FL",
            "postal_code": "33706",
            "telephone_number": "858-837-1128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 COUNTRYSIDE BLVD STE A",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337631603",
            "telephone_number": "727-475-7519"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12264 El Camino Real",
            "address_2": "Suite 206",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921303058",
            "country_code": "US",
            "telephone_number": "858-755-4787",
            "fax_number": "858-755-7704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOSAKOSKI",
        "first_name": "EDWARD",
        "middle_name": "DWIGHT",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-07",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "FL",
            "license": "DN10933",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "36125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "330924971",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenneth Edward Kopitzke
• Heidi Gale Korn
• David Samuel Kornblum, MD
• Angela M. Korte, D.C.
• Kimberly Korthanke
• Carly Grace Kosciolek, AUD
• Henry Jerome Koser, DO
• Aaron Koslin, D.O.
• Yelizaveta Kotlyarova, DPM
• Jason M Kotun, AA

• Endodontics in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Endodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.