Provider Demographics
NPI:1770640336
Name:KOZLOWSKI, MARK ALOYSIUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALOYSIUS
Last Name:KOZLOWSKI
Suffix:
Gender:M
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:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-0566
Mailing Address - Country:US
Mailing Address - Phone:860-848-1291
Mailing Address - Fax:860-848-9238
Practice Address - Street 1:620 NORWICH NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-2121
Practice Address - Country:US
Practice Address - Phone:860-848-1291
Practice Address - Fax:860-848-9238
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0062001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice