Provider Demographics
NPI:1750501045
Name:ROBERT J. KOZLOW, D.D.S. P.L.L.C.
Entity Type:Organization
Organization Name:ROBERT J. KOZLOW, D.D.S. P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOZLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-279-7138
Mailing Address - Street 1:P.O. BOX 204
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-0204
Mailing Address - Country:US
Mailing Address - Phone:603-279-7138
Mailing Address - Fax:603-279-7209
Practice Address - Street 1:14 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253-0204
Practice Address - Country:US
Practice Address - Phone:603-279-7138
Practice Address - Fax:603-279-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty