MEDICARE: KOZLOW AND ROWELL DENTISTRY PLLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1770117061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOZLOW AND ROWELL DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	5050 QUORUM DR STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-1488
Country	:	US
Telephone Number	:	972-458-2464
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 QUORUM DR STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-1488
Country	:	US
Telephone Number	:	972-458-2464
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. JIMMY LEE MAYO II
Credential	:
Telephone Number	:	512-988-7635

Provider Enumeration Date	:	02/26/2020
Last Update Date	:	08/19/2020

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