Provider Demographics
NPI:1649354374
Name:KOZLOWSKI, JOHN R (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:KOZLOWSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BEAVER BROOK RD
Mailing Address - Street 2:
Mailing Address - City:LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371
Mailing Address - Country:US
Mailing Address - Phone:860-434-1030
Mailing Address - Fax:860-434-1066
Practice Address - Street 1:196 PARKWAY SOUTH
Practice Address - Street 2:SUITE 305
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-443-1827
Practice Address - Fax:860-437-2255
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46941223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics