Provider Demographics
NPI:1225440001
Name:BIELOZER, KACY (DDS)
Entity Type:Individual
Prefix:
First Name:KACY
Middle Name:
Last Name:BIELOZER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42707 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1054
Mailing Address - Country:US
Mailing Address - Phone:440-444-0379
Mailing Address - Fax:440-324-3470
Practice Address - Street 1:42707 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1054
Practice Address - Country:US
Practice Address - Phone:440-444-0379
Practice Address - Fax:440-324-3470
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH330024218122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist