Provider Demographics
NPI:1669675815
Name:KOZYK, STEVAN JONATHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVAN
Middle Name:JONATHAN
Last Name:KOZYK
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 1:9701 BROOKPARK RD
Mailing Address - Street 2:SUITE 223
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-6824
Mailing Address - Country:US
Mailing Address - Phone:216-661-4900
Mailing Address - Fax:216-661-0330
Practice Address - Street 1:9701 BROOKPARK RD
Practice Address - Street 2:SUITE 223
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-6824
Practice Address - Country:US
Practice Address - Phone:216-661-4900
Practice Address - Fax:216-661-0330
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1391-0122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist