Healthcare Provider Details

I. General information

NPI: 1992835219
Provider Name (Legal Business Name): JOHN F. KOZAL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7336 ARCHER AVE
SUMMIT IL
60501-1230
US

IV. Provider business mailing address

7336 ARCHER AVE
SUMMIT IL
60501-1230
US

V. Phone/Fax

Practice location:
  • Phone: 708-458-8585
  • Fax: 708-458-9663
Mailing address:
  • Phone: 708-458-8585
  • Fax: 708-458-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: