Provider Demographics
NPI:1285092650
Name:COZI DENTAL, PLLC
Entity type:Organization
Organization Name:COZI DENTAL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-495-7900
Mailing Address - Street 1:1545 E MAIN ST
Mailing Address - Street 2:STE 200
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-4488
Mailing Address - Country:US
Mailing Address - Phone:214-495-7900
Mailing Address - Fax:214-495-7910
Practice Address - Street 1:1545 E MAIN ST
Practice Address - Street 2:STE 200
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-4488
Practice Address - Country:US
Practice Address - Phone:214-495-7900
Practice Address - Fax:214-495-7910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX277961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1235441221OtherNPI TYPE 1