Provider Demographics
NPI:1356344881
Name:KOZINN, EDWARD J (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:KOZINN
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 1:961 HUNTINGTON TPKE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-1247
Mailing Address - Country:US
Mailing Address - Phone:203-372-6640
Mailing Address - Fax:203-377-3345
Practice Address - Street 1:961 HUNTINGTON TPKE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-1247
Practice Address - Country:US
Practice Address - Phone:203-372-6640
Practice Address - Fax:203-377-3345
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT65331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice