Provider Demographics
NPI:1689262818
Name:ALEKSEY KOZLOV, D.M.D., LLC
Entity Type:Organization
Organization Name:ALEKSEY KOZLOV, D.M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZLOV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-247-2048
Mailing Address - Street 1:13150 WENONAH AVE SE APT 521
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-3857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 BIRCH ROAD
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008
Practice Address - Country:US
Practice Address - Phone:505-281-2622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1124513288OtherNPI