Individual
DR. MARK FRANKLIN KOZACKO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS PA
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
6836
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9016W
BCBS NC PROVIDER NUMBER
NC
Enumeration date
06/24/2006
Last updated
07/09/2007
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