Provider Demographics
NPI:1922218817
Name:KOZLOSKI, KIMBERLY ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:KOZLOSKI
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 1:1295 TERRELL MILL RD SE
Mailing Address - Street 2:102
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-9438
Mailing Address - Country:US
Mailing Address - Phone:770-952-5200
Mailing Address - Fax:770-952-5245
Practice Address - Street 1:1295 TERRELL MILL RD SE
Practice Address - Street 2:102
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9438
Practice Address - Country:US
Practice Address - Phone:770-952-5200
Practice Address - Fax:770-952-5245
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0117801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20-8043096OtherTIN