Aleksey Kozlov, DMD
Individual provider Active NPI General Practice Dentistry · Cedar Crest, NM
NPI 1124513288 · NPPES record last updated Apr 2, 2025
Key facts
- NPI
- 1124513288
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DD4950 (NM)
- Practice address
- 2 Birch Rd
Cedar Crest, NM 87008-9553 - Phone
- (505) 281-2622
- Fax
- (505) 407-4044
- NPI assigned
- Jun 29, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180824000465 | NM | Order and Referring Only - Dentist |
6800145889 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD4950 | NM | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aleksey Kozlov, D.M.D., LLC | Current |
Accepting new patients | |
| Kidskare P.C. | General Practice | Past | Accepting new patients |
Locations
2 Birch Rd
Cedar Crest, NM 87008
Phone (505) 281-2622
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DD4950 | NM | Yes |
Addresses
Primary practice location
2 Birch Rd
Cedar Crest, NM 87008-9553
Mailing address
PO Box 979
Cedar Crest, NM 87008-0979
Phone (505) 281-2622
Other providers in Cedar Crest, NM
- Justin Andrew Kan
- Monique Y Keulen-Nolet
- Tammie C Kiddy-Knight
- Callie Knapp
- Courtney Kolb
- Stephen Alexander Lajoie
- Sadie Jane Lewis
- Lisa Marie Stolarczyk MD PHD
- Jerome Arthur Lopez-Silva
- Amanda Macewen
All providers in Cedar Crest, NM · General Practice Dentistry in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.