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General NPI Number Information
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NPI Number | 1700219243
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Entity Type | Organization
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Legal Business Name | STRATFORD ORTHODONTICS
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 2499 MAIN STREET
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City | STRATFORD
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State | CT
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Zip | 06615
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Country | US
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Telephone | 860-442-4421
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Fax | 866-837-6409
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Provider Business Mailing Address
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Address Line | 2499 MAIN STREET
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City | STRATFORD
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State | CT
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Zip | 06615
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Country | US
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Telephone | 860-442-4421
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Fax | 866-837-6409
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY TODD KOZLOWSKI
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Credential | DDS
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Telephone | 860-442-4421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8376
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License Number State | CT
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