Provider Demographics
NPI:1316185234
Name:MICHAEL J. KUZMA DDS PA
Entity Type:Organization
Organization Name:MICHAEL J. KUZMA DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KUZMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-392-6060
Mailing Address - Street 1:3505 CONVERSE DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:910-392-6060
Mailing Address - Fax:910-392-0052
Practice Address - Street 1:3505 CONVERSE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-392-6060
Practice Address - Fax:910-392-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty