Provider Demographics
NPI:1700395977
Name:KOZAK, KATHE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHE
Middle Name:
Last Name:KOZAK
Suffix:
Gender:F
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:STATE CORRECTIONAL INSTITUTION-HUNTINGDON
Mailing Address - Street 2:1100 PIKE ST.
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16654-1112
Mailing Address - Country:US
Mailing Address - Phone:814-643-2400
Mailing Address - Fax:814-506-1182
Practice Address - Street 1:1100 PIKE ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16654-0002
Practice Address - Country:US
Practice Address - Phone:814-643-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-024790L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice