NPIMap

Organization Active NPI

Mystic Westerly Orthodontics, PC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Mystic, CT
National Provider Identifier
1174933162
Registry record updated Apr 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
8376 Issued in CT
Legal business name
MYSTIC WESTERLY ORTHODONTICS, PC
Practice address
117 Cow Hill Rd
Mystic, CT 06355-1449
Phone
(860) 536-9661
NPI assigned
Apr 30, 2014
Last updated
Apr 30, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2014

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

Authorized official

Name
Dr. Jeffrey Todd Kozlowski, DDSNPI 1659456382
Title
President
Phone
(860) 442-4421

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 8376 CT Primary

Addresses

Primary practice location

117 Cow Hill Rd
Mystic, CT 06355-1449

Mailing address

117 Cow Hill Rd
Mystic, CT 06355-1449
Phone (860) 536-9661

National Provider Directory

National Provider Directory

Locations

117 Cow Hill Rd
Mystic, CT 06355
Phone (860) 536-4951

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1398816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398816000000",
    "number": "1174933162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 COW HILL RD",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551449",
            "telephone_number": "860-536-9661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 COW HILL RD",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551449",
            "telephone_number": "860-536-9661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC WESTERLY ORTHODONTICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-30",
        "last_updated": "2014-04-30",
        "status": "A",
        "authorized_official_last_name": "KOZLOWSKI",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-442-4421",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CT",
            "license": "8376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mystic, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.