Bryon Richard Kozak, DDS, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

5281-015 Issued in WI

Practice address

10320 75TH St
Suite a
Kenosha, WI 53142-7525

Phone

(262) 697-8766

Fax

(262) 697-5523

NPI assigned

Mar 29, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kozak Orthodontics PC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Lake Forest, IL
  • NPI 1588834972
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393200000000",
    "number": "1104946912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10320 75TH ST",
            "address_2": "SUITE A",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427525",
            "telephone_number": "262-697-8766",
            "fax_number": "262-697-5523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10320 75TH ST",
            "address_2": "SUITE A",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427525",
            "telephone_number": "262-697-8766",
            "fax_number": "262-697-5523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZAK",
        "first_name": "BRYON",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2014-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WI",
            "license": "5281-015",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "19-025556",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Connie Kornman, RN
• Diane E Kosar
• Becky Koss, RN, CDE
• Samual Dean Kotsonas
• Karen Marie Kowalski, PTA
• Dorothy Kozakowski, DNP, APN
• Sarah Kramer, COTA
• James C Kranz, M.D.
• Andrew Kraska-Anderson, RPH
• Jamie Marie Krasnesky, PMHNP-BC

• Orthodontics and Dentofacial Orthopedics Dentistry in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.