Healthcare Provider Details

I. General information

NPI: 1871225672
Provider Name (Legal Business Name): SETH ALAN KOCZELA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MAIN ST
BROCKTON MA
02301-4027
US

IV. Provider business mailing address

4 MAIN ST APT 4
BROCKTON MA
02301-4027
US

V. Phone/Fax

Practice location:
  • Phone: 508-587-7775
  • Fax:
Mailing address:
  • Phone: 508-587-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1859450
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: