Provider Demographics
NPI:1174514038
Name:KOZIK, KENNETH MILAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MILAN
Last Name:KOZIK
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 1:9021 S COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-4304
Mailing Address - Country:US
Mailing Address - Phone:773-978-5490
Mailing Address - Fax:773-978-5490
Practice Address - Street 1:9021 S COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4304
Practice Address - Country:US
Practice Address - Phone:773-978-5490
Practice Address - Fax:773-978-5490
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice