NPIMap

Organization Active NPI

Kozak Orthodontics, P.C.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Antioch, IL
National Provider Identifier
1164754016
Registry record updated Feb 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
19-025556 Issued in IL
Legal business name
KOZAK ORTHODONTICS, P.C.
Practice address
1326 Main St
Suite B
Antioch, IL 60002-2181
Phone
(847) 603-1682
NPI assigned
Feb 3, 2010
Last updated
Feb 3, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2010

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

Authorized official

Name
Dr. Bryon R Kozak, DDS, MS
Title
Orthodontist
Phone
(847) 603-1682

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 19-025556 IL Primary

Addresses

Primary practice location

1326 Main St
Suite B
Antioch, IL 60002-2181

Mailing address

1326 Main St
Suite B
Antioch, IL 60002-2181
Phone (847) 603-1682

National Provider Directory

National Provider Directory
Tax ID family
Kozak Orthodontics PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1326 Main St
Ste B
Antioch, IL 60002
Phone (847) 603-1682

NPI Registry JSON

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

{
    "created_epoch": "1265155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265155200000",
    "number": "1164754016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1326 MAIN ST",
            "address_2": "SUITE B",
            "city": "ANTIOCH",
            "state": "IL",
            "postal_code": "600022181",
            "telephone_number": "847-603-1682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1326 MAIN ST",
            "address_2": "SUITE B",
            "city": "ANTIOCH",
            "state": "IL",
            "postal_code": "600022181",
            "telephone_number": "847-603-1682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOZAK ORTHODONTICS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-03",
        "last_updated": "2010-02-03",
        "status": "A",
        "authorized_official_last_name": "KOZAK",
        "authorized_official_first_name": "BRYON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ORTHODONTIST",
        "authorized_official_telephone_number": "847-603-1682",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "19-025556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Antioch, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2010; 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.