Provider Demographics
NPI:1306929401
Name:KASZUBA, JAMES STANLEY (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:STANLEY
Last Name:KASZUBA
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 1:1704 PATTON DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-8137
Mailing Address - Country:US
Mailing Address - Phone:219-836-9999
Mailing Address - Fax:219-836-0644
Practice Address - Street 1:1704 PATTON DR STE 1
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-8137
Practice Address - Country:US
Practice Address - Phone:203-530-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019018246122300000X
ININ12009211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist