Provider Demographics
NPI:1831352954
Name:KAZLOW, ALAN R
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:KAZLOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:VIOLET
Other - Middle Name:R
Other - Last Name:R
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:407 EAST JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514
Mailing Address - Country:US
Mailing Address - Phone:516-747-8150
Mailing Address - Fax:516-747-8152
Practice Address - Street 1:166 ROSELLE ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2038
Practice Address - Country:US
Practice Address - Phone:516-746-6093
Practice Address - Fax:516-747-8152
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice