Provider Demographics
NPI:1225253586
Name:JOHN S KITZMILLER III DDS PLLC
Entity Type:Organization
Organization Name:JOHN S KITZMILLER III DDS PLLC
Other - Org Name:APEX DENTAL GROUP, DR JOHN S KITZMILLER III & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:KITZMILLER
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-362-1341
Mailing Address - Street 1:1021 W WILLIAMS ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3956
Mailing Address - Country:US
Mailing Address - Phone:919-362-1341
Mailing Address - Fax:919-362-9656
Practice Address - Street 1:1021 W WILLIAMS ST
Practice Address - Street 2:SUITE 101
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3956
Practice Address - Country:US
Practice Address - Phone:919-362-1341
Practice Address - Fax:919-362-9656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC57191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty