Provider Demographics
NPI:1548317449
Name:KOZLOWSKI, THEODORE A (DDS)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:A
Last Name:KOZLOWSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 FALLSTON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-1300
Mailing Address - Country:US
Mailing Address - Phone:410-692-0738
Mailing Address - Fax:410-692-0739
Practice Address - Street 1:2741 FALLSTON RD
Practice Address - Street 2:SUITE A
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-1300
Practice Address - Country:US
Practice Address - Phone:410-692-0738
Practice Address - Fax:410-692-0739
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist