Robert Stephen Kozelka, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19A15430 Issued in IL

Practice address

101 S Washington Ave
Park Ridge, IL 60068-4200

Phone

(847) 823-7910

Fax

(847) 823-7960

NPI assigned

Aug 4, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811905987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S WASHINGTON AVE",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684200",
            "telephone_number": "847-823-7910",
            "fax_number": "847-823-7960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S WASHINGTON AVE",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684200",
            "telephone_number": "847-823-7910",
            "fax_number": "847-823-7960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZELKA",
        "first_name": "ROBERT",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19A15430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kasey Kotsiris, OTR/L
• Susan Kottra, LCSW
• Dejan Kotur, DC
• Brenna Kathleen Kouzoukas, FNP-BC
• Ivan Kovbel, MD
• Kamila Kozicki-Bonnert, M.H.S.-CCC/SLP/L
• Donald John Koziol, M.D.
• Nikola Ewa Koziol
• KP Dental Inc.
• Wendy Frech Kramer, L.C.S.W.

• General Practice Dentistry in Park Ridge, IL
• Providers in Park Ridge, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.