Provider Demographics
NPI:1326119736
Name:KOZLOVSKY, EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:KOZLOVSKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SCHOOL RD E
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2058
Mailing Address - Country:US
Mailing Address - Phone:732-625-2244
Mailing Address - Fax:732-625-1244
Practice Address - Street 1:15 SCHOOL RD E
Practice Address - Street 2:SUITE #1
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2058
Practice Address - Country:US
Practice Address - Phone:732-625-2244
Practice Address - Fax:732-625-1244
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021853001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery