Healthcare Provider Details

I. General information

NPI: 1225730823
Provider Name (Legal Business Name): KARA LEE KOCZERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 PINE GROVE ST
NEW BEDFORD MA
02745-2505
US

IV. Provider business mailing address

172 PINE GROVE ST
NEW BEDFORD MA
02745-2505
US

V. Phone/Fax

Practice location:
  • Phone: 508-728-2080
  • Fax:
Mailing address:
  • Phone: 508-728-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH90028
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: