Provider Demographics
NPI:1184472979
Name:KP DENTAL INC
Entity type:Organization
Organization Name:KP DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KOZLAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-307-4193
Mailing Address - Street 1:3 SWEETHEART MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06019-3425
Mailing Address - Country:US
Mailing Address - Phone:860-307-4193
Mailing Address - Fax:
Practice Address - Street 1:10 HINSDALE AVE
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098-1133
Practice Address - Country:US
Practice Address - Phone:860-379-4382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty