Provider Demographics
NPI:1447862123
Name:MARYNA KOZYRYEV DDS INC
Entity type:Organization
Organization Name:MARYNA KOZYRYEV DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZYRYEV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-534-7178
Mailing Address - Street 1:5460 SUNRISE BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7851
Mailing Address - Country:US
Mailing Address - Phone:916-534-7178
Mailing Address - Fax:916-534-7460
Practice Address - Street 1:5460 SUNRISE BLVD STE 5
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7851
Practice Address - Country:US
Practice Address - Phone:916-534-7178
Practice Address - Fax:916-534-7460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-23
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental