Healthcare Provider Details

I. General information

NPI: 1649291444
Provider Name (Legal Business Name): DAVID JOSEPH KOZAR DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14601 DETROIT AVE STE 500
LAKEWOOD OH
44107
US

IV. Provider business mailing address

14601 DETROIT AVE STE 500
LAKEWOOD OH
44107
US

V. Phone/Fax

Practice location:
  • Phone: 216-221-8744
  • Fax: 216-221-8745
Mailing address:
  • Phone: 216-221-8744
  • Fax: 216-221-8745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30015460
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: