Provider Demographics
NPI:1316978026
Name:OSGOOD KOTLEWSKI, KRISTIN LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LYNN
Last Name:OSGOOD KOTLEWSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:L
Other - Last Name:OSGOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4554 W ALESCI DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8170
Mailing Address - Country:US
Mailing Address - Phone:414-423-5665
Mailing Address - Fax:
Practice Address - Street 1:10155 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:STURTEVANT
Practice Address - State:WI
Practice Address - Zip Code:53177-1645
Practice Address - Country:US
Practice Address - Phone:262-884-3011
Practice Address - Fax:262-664-7799
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4902122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33742300Medicaid