Organization
MARK KOZACKO DDS PA
Active
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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