Provider Demographics
NPI:1821281247
Name:CHERIE S. KOZELSKY, D.D.S., P.A.
Entity Type:Organization
Organization Name:CHERIE S. KOZELSKY, D.D.S., P.A.
Other - Org Name:LEON SPRINGS FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOZELSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-698-0610
Mailing Address - Street 1:24165 IH 10 W
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1159
Mailing Address - Country:US
Mailing Address - Phone:210-698-0610
Mailing Address - Fax:210-698-0631
Practice Address - Street 1:24165 IH 10 W
Practice Address - Street 2:SUITE 125
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1159
Practice Address - Country:US
Practice Address - Phone:210-698-0610
Practice Address - Fax:210-698-0631
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEON SPRINGS FAMILY DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty