Provider Demographics
NPI:1871225672
Name:KOCZELA, SETH ALAN (DMD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:ALAN
Last Name:KOCZELA
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 1:4 MAIN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4027
Mailing Address - Country:US
Mailing Address - Phone:508-587-7775
Mailing Address - Fax:
Practice Address - Street 1:4 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4027
Practice Address - Country:US
Practice Address - Phone:508-587-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859450122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist