Provider Demographics
NPI:1811909906
Name:KOZELUH, DAVID WILLIAM (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:KOZELUH
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 1:8796 BRUNSWICK RD
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-9346
Mailing Address - Country:US
Mailing Address - Phone:715-356-2060
Mailing Address - Fax:715-358-6420
Practice Address - Street 1:8796 BRUNSWICK RD
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9346
Practice Address - Country:US
Practice Address - Phone:715-356-2060
Practice Address - Fax:715-358-6420
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2864122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist