Provider Demographics
NPI:1649896069
Name:RICHARD S. KOZLOWSKI, DDS
Entity type:Organization
Organization Name:RICHARD S. KOZLOWSKI, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-748-3906
Mailing Address - Street 1:1229 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-2697
Mailing Address - Country:US
Mailing Address - Phone:802-748-3906
Mailing Address - Fax:802-748-5456
Practice Address - Street 1:1229 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2697
Practice Address - Country:US
Practice Address - Phone:802-748-3906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty