Provider Demographics
NPI:1023442878
Name:KOZLOW, PHILIP (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:KOZLOW
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 1:5050 QUORUM DR STE 340
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7039
Mailing Address - Country:US
Mailing Address - Phone:972-458-2464
Mailing Address - Fax:972-458-2584
Practice Address - Street 1:5050 QUORUM DR
Practice Address - Street 2:STE 340
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7564
Practice Address - Country:US
Practice Address - Phone:972-458-2464
Practice Address - Fax:972-458-2584
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11502122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist