Provider Demographics
NPI:1659471605
Name:GENERAL RECONSTRUCTIVE & COSMETIC DENTISTRY INC
Entity Type:Organization
Organization Name:GENERAL RECONSTRUCTIVE & COSMETIC DENTISTRY INC
Other - Org Name:PAUL S KOZY DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOZY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-578-2380
Mailing Address - Street 1:3349 EXECUTIVE PKWY
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606
Mailing Address - Country:US
Mailing Address - Phone:419-578-2380
Mailing Address - Fax:419-578-2381
Practice Address - Street 1:3349 EXECUTIVE PKWY
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-578-2380
Practice Address - Fax:419-578-2381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty