Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 39291 | CA |
NPI | 1194870501 |
---|---|
Provider Name | Dr. Ronald Ira Koslowski |
First Address | Encino, CA 91436-2124 |
Second Address | Encino, CA 91436-2124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |