Basic Information
| Provider Information | |||||||||
| NPI: | 1891248035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSMA | ||||||||
| FirstName: | ANDREEA-ALEXANDRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10177 W GRAND PKWY S STE 103 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774078643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3467023085 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7505 GRAND LELY DR | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2397753052 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2016 | ||||||||
| LastUpdateDate: | 08/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 1603 | FL | N | Dental Providers | Dentist | 1223P0221X | 34412 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.