Provider Demographics
NPI:1659456382
Name:KOZLOWSKI, JEFFREY TODD (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:TODD
Last Name:KOZLOWSKI
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 1:17 WILLOW LANE
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333
Mailing Address - Country:US
Mailing Address - Phone:860-691-2691
Mailing Address - Fax:
Practice Address - Street 1:190 HEMPSTEAD STREET
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-442-4421
Practice Address - Fax:866-837-6409
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT83761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics