Provider Demographics
NPI:1104946912
Name:KOZAK, BRYON RICHARD (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BRYON
Middle Name:RICHARD
Last Name:KOZAK
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:10320 75TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7525
Mailing Address - Country:US
Mailing Address - Phone:262-697-8766
Mailing Address - Fax:262-697-5523
Practice Address - Street 1:10320 75TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7525
Practice Address - Country:US
Practice Address - Phone:262-697-8766
Practice Address - Fax:262-697-5523
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2014-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI5281-0151223X0400X
IL19-0255561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics