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General NPI Number Information
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NPI Number | 1669702122
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Entity Type | Organization
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Legal Business Name | MEDINA PEDIATRIC DENTAL ASSOCIATES
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 3443 MEDINA RD SUITE 104
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City | MEDINA
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State | OH
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Zip | 44256-5360
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Country | US
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Telephone | 330-391-1157
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Fax |
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Provider Business Mailing Address
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Address Line | 3443 MEDINA RD SUITE 104
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City | MEDINA
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State | OH
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Zip | 44256-5360
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES KOZIK
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Credential | D.D.S.
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Telephone | 330-391-1157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 18125
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License Number State | OH
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