Provider Demographics
NPI:1275684706
Name:KOZAK, JAMES J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:KOZAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8685 LA MESA BLVD # F
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-3903
Mailing Address - Country:US
Mailing Address - Phone:619-463-0393
Mailing Address - Fax:619-463-8346
Practice Address - Street 1:8685 LA MESA BLVD # F
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-3903
Practice Address - Country:US
Practice Address - Phone:619-463-0393
Practice Address - Fax:619-463-8346
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice