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General NPI Number Information
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NPI Number | 1215345939
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Entity Type | Organization
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Legal Business Name | MARK KOLOZENSKI, DDS, MS, PC
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Dates
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Enumeration Date | 07/25/2014
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 10083 W LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-1272
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Country | US
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Telephone | 815-201-1000
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Fax | 815-201-1111
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Provider Business Mailing Address
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Address Line | 10083 W LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-1272
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Country | US
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Telephone | 815-201-1000
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Fax | 815-201-1111
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MARK A KOLOZENSKI
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Credential | DDS
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Telephone | 815-201-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 021001669
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License Number State | IL
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