Provider Demographics
NPI:1902061443
Name:KOZY, BRIDGET BEVERLY (DDS)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:BEVERLY
Last Name:KOZY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 EXECUTIVE PKWY
Mailing Address - Street 2:SUITE F
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1376
Mailing Address - Country:US
Mailing Address - Phone:419-578-2380
Mailing Address - Fax:419-578-2381
Practice Address - Street 1:3349 EXECUTIVE PKWY
Practice Address - Street 2:SUITE F
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1376
Practice Address - Country:US
Practice Address - Phone:419-578-2380
Practice Address - Fax:419-578-2381
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300226071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice