Healthcare Provider Details

I. General information

NPI: 1194996298
Provider Name (Legal Business Name): DIANA KOZLOWSKI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 E STATE ROAD 32
WESTFIELD IN
46074-8767
US

IV. Provider business mailing address

526 E STATE ROAD 32
WESTFIELD IN
46074-8767
US

V. Phone/Fax

Practice location:
  • Phone: 317-896-9600
  • Fax: 317-896-9696
Mailing address:
  • Phone: 317-896-9600
  • Fax: 317-896-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12010837A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: