Stephen Koza, DMD
Individual provider Active NPI General Practice Dentistry · Lagrande, OR
NPI 1861552085 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1861552085
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D8404 (OR)
- Practice address
- 2502 Cove Ave
Suite D
Lagrande, OR 97850 - Phone
- (541) 963-4962
- NPI assigned
- Dec 11, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- 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 |
|---|---|---|---|---|
| I20260102002150 | OR | Order and Referring Only - Dentist |
0244543791 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8404 | OR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Koza Family Dental Care PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D8404 | OR | Yes |
Addresses
Primary practice location
2502 Cove Ave
Suite D
Lagrande, OR 97850
Mailing address
63970A McDonald LN
La Grande, OR 97850-5157
Phone (541) 963-3202
Other providers in Lagrande, OR
- Center for Human Development, Inc.
- Hanks Chiropractic PC
- Khalil Yoseph Helou
- Genevieve Elizabeth Ludwig
- James Michael Matthews
- Anne Wiltsie Vaniea
All providers in Lagrande, OR · General Practice Dentistry in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.