Provider Demographics
NPI:1225652449
Name:KALUZNY, JOSHUA VIRGINIO TAVARES (DDS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:VIRGINIO TAVARES
Last Name:KALUZNY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989375 NEBRASKA MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-9375
Mailing Address - Country:US
Mailing Address - Phone:402-559-6327
Mailing Address - Fax:402-559-9607
Practice Address - Street 1:989375 NEBRASKA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-9375
Practice Address - Country:US
Practice Address - Phone:402-559-6327
Practice Address - Fax:402-559-9607
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE76651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice