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General NPI Number Information
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NPI Number | 1508903063
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Entity Type | Individual
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Provider Name | MARK KOZLOWSKI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1000 W WALLINGS RD SUITE D
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City | BROADVIEW HTS
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State | OH
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Zip | 44147-1200
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Country | US
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Telephone | 440-546-9522
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Fax | 440-546-9564
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Provider Business Mailing Address
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Address Line | 1000 W WALLINGS RD SUITE D
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City | BROADVIEW HTS
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State | OH
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Zip | 44147-1200
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Country | US
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Telephone | 440-546-9522
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Fax | 440-546-9564
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30016184
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License Number State | OH
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