Active NPI
Kelly Bliss Koscso, D.M.D.
- Dentist
- Gainesville, FL
National Provider Identifier
1710113899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN18633
- Practice address
- 410 NE Waldo Rd
Gainesville, FL 32641-5685 - Phone
- (352) 375-3790
- Fax
- (352) 375-3791
- NPI assigned
- Jun 3, 2009
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | DN18633 | FL | Primary |
Addresses
Primary practice location
410 NE Waldo Rd
Gainesville, FL 32641-5685
Mailing address
410 NE Waldo Rd
Gainesville, FL 32641-5685
Phone (352) 375-3790
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 |
|---|---|---|---|
| DN18633 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326240000000",
"number": "1710113899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 NE WALDO RD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326415685",
"telephone_number": "352-375-3790",
"fax_number": "352-375-3791"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 NE WALDO RD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326415685",
"telephone_number": "352-375-3790",
"fax_number": "352-375-3791"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOSCSO",
"first_name": "KELLY",
"middle_name": "BLISS",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-03",
"last_updated": "2012-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN18633",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.