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Organization

MARK KOZACKO DDS PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MARK FRANKLIN KOZACKO DDS (PRESIDENT)
(919) 848-9871
Entity
Organization

Contact information

Practice address
6817 FALLS OF NEUSE RD, SUITE 101, RALEIGH, NC 27615-5386
(919) 848-9871
(919) 848-7841
Mailing address
6817 FALLS OF NEUSE RD, SUITE 101, RALEIGH, NC 27615-5386
(919) 848-9871
(919) 848-7841

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
899016W
NC
Enumeration date
01/10/2008
Last updated
02/25/2008
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