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General NPI Number Information
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NPI Number | 1023442878
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Entity Type | Individual
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Provider Name | PHILIP KOZLOW D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 5050 QUORUM DR STE 340
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City | DALLAS
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State | TX
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Zip | 75254-7564
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Country | US
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Telephone | 972-458-2464
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Fax | 972-458-2584
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Provider Business Mailing Address
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Address Line | 5050 QUORUM DR STE 340
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City | DALLAS
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State | TX
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Zip | 75254-7039
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Country | US
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Telephone | 972-458-2464
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Fax | 972-458-2584
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11502
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License Number State | TX
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