Douglas John Kosek, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12009873 Issued in IN

Practice address

413 W Jefferson Blvd
South Bend, IN 46601-1514

Phone

(574) 232-2992

Fax

(574) 232-2739

NPI assigned

Mar 29, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Select Dental Associates PC

  • General Practice Dentistry
  • South Bend, IN
  • NPI 1457850687
  NPD Authorized official
• Douglas J Kosek DDS PC

  • General Practice Dentistry
  • South Bend, IN
  • NPI 1811064215
  NPD (past) Authorized official
• Douglas J Kosek D.D.S., P.C.

  • Dental Clinic/Center
  • South Bend, IN
  • NPI 1992294276
  NPD

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780704247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "533 N COQUILLARD DR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172554",
            "telephone_number": "574-288-3308",
            "fax_number": "574-232-2739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 W JEFFERSON BLVD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011514",
            "telephone_number": "574-232-2992",
            "fax_number": "574-232-2739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSEK",
        "first_name": "DOUGLAS",
        "middle_name": "JOHN",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12009873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melinda Konrath, RN
• Abigail Marie Korb, PA-C
• Jane Korson, MSW, LSW
• Kimberly J Koscher, BS
• Matthew Francis Koscielski, M.D.
• Zdzislaw Jerry Kosel, MD
• Joey Koselak, MSW
• Stephanie Kostizen, MSW
• Rebekah Kottkamp, FNP-BC
• Mary Kowalski, LCSW

• General Practice Dentistry in South Bend, IN
• Providers in South Bend, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.