Provider Demographics
NPI:1164683371
Name:KUZMA, MARK A (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:KUZMA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1740
Mailing Address - Country:US
Mailing Address - Phone:270-651-2638
Mailing Address - Fax:270-651-2638
Practice Address - Street 1:501 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1740
Practice Address - Country:US
Practice Address - Phone:270-651-2638
Practice Address - Fax:270-651-2638
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY58881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice