Organization
KOZAK ORTHODONTICS PC
Active
Other names
North Shore Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
BRYON R KOZAK DDS, MS (PRESIDENT)
(262) 697-8766
Entity
Organization
Contact information
Practice address
225 E DEERPATH STE 280, LAKE FOREST, IL 60045-1973
(847) 234-4400
Mailing address
10320 75TH ST STE A, KENOSHA, WI 53142-7525
(262) 697-8766
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104946912
NPI
IL
Enumeration date
03/03/2008
Last updated
03/03/2008
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