Provider Demographics
NPI:1487234381
Name:KOZAK, KAREN (DDS)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KOZAK
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 1:2470 MANDEVILLE LN APT 824
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4891
Mailing Address - Country:US
Mailing Address - Phone:913-660-4187
Mailing Address - Fax:
Practice Address - Street 1:800 W BROAD ST STE 207
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3144
Practice Address - Country:US
Practice Address - Phone:703-998-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN20000941223G0001X
MD171821223G0001X
VA04014171571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice