Healthcare Provider Details

I. General information

NPI: 1265642219
Provider Name (Legal Business Name): GREGORY G KOZLOWSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 KLA-OOK-WA DR
TAHOLAH WA
98587
US

IV. Provider business mailing address

1143 OCEAN SHORES BLVD SW
OCEAN SHORES WA
98569-9783
US

V. Phone/Fax

Practice location:
  • Phone: 360-276-4405
  • Fax: 360-276-4474
Mailing address:
  • Phone: 360-276-4405
  • Fax: 360-276-4474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2570
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: