MEDICARE: DR. STEVAN JONATHAN KOZYK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	1391-0	OH

General Provider Information

NPI Number	:	1669675815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVAN JONATHAN KOZYK DDS

Provider Business Mailing Address
First Line	:	9701 BROOKPARK RD
Second Line	:	SUITE 223
City	:	PARMA
State	:	OH
Zip	:	44129-6824
Country	:	US
Telephone Number	:	216-661-4900
Fax Number	:	216-661-0330

Provider Business Practice Location Address
First Line	:	9701 BROOKPARK RD
Second Line	:	SUITE 223
City	:	PARMA
State	:	OH
Zip	:	44129-6824
Country	:	US
Telephone Number	:	216-661-4900
Fax Number	:	216-661-0330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/08/2007

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