Healthcare Provider Details

I. General information

NPI: 1679634117
Provider Name (Legal Business Name): SARAH KOZAK RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W BOUGHTON RD SUITE B
BOLINGBROOK IL
60440-1340
US

IV. Provider business mailing address

30430 KAVANAUGH RD
WILMINGTON IL
60481
US

V. Phone/Fax

Practice location:
  • Phone: 630-759-8940
  • Fax: 630-759-9392
Mailing address:
  • Phone: 815-476-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: