Active NPI
Amanda Lee Kossick, DMD
- General Practice Dentistry
- Roswell, GA
National Provider Identifier
1629400403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN014645
- Practice address
- 10930 Crabapple Rd
Suite 140
Roswell, GA 30075-5813 - Phone
- (770) 641-8010
- NPI assigned
- Aug 5, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN014645 | GA | Primary |
Addresses
Primary practice location
10930 Crabapple Rd
Suite 140
Roswell, GA 30075-5813
Mailing address
10930 Crabapple Rd
Suite 140
Roswell, GA 30075-5813
Phone (770) 641-8010
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN014645 | GA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375660800000",
"number": "1629400403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10930 CRABAPPLE RD",
"address_2": "SUITE 140",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300755813",
"telephone_number": "770-641-8010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10930 CRABAPPLE RD",
"address_2": "SUITE 140",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300755813",
"telephone_number": "770-641-8010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOSSICK",
"first_name": "AMANDA",
"middle_name": "LEE",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-05",
"last_updated": "2013-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN014645",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roswell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.