Healthcare Provider Details

I. General information

NPI: 1962336172
Provider Name (Legal Business Name): KENDRA KOZISEK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 N COTNER BLVD
LINCOLN NE
68505-2315
US

IV. Provider business mailing address

343 N COTNER BLVD
LINCOLN NE
68505-2315
US

V. Phone/Fax

Practice location:
  • Phone: 402-466-1914
  • Fax: 402-475-8741
Mailing address:
  • Phone: 402-466-1914
  • Fax: 402-475-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8222
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: