Provider Demographics
NPI:1326796095
Name:KUZMIC ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:KUZMIC ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:JONATHON
Authorized Official - Last Name:KUZMIC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:317-833-6185
Mailing Address - Street 1:2772 GASTON AVE APT 1533
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-2755
Mailing Address - Country:US
Mailing Address - Phone:317-833-6185
Mailing Address - Fax:
Practice Address - Street 1:8902 N MERIDIAN ST STE 137
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5306
Practice Address - Country:US
Practice Address - Phone:317-846-4446
Practice Address - Fax:317-846-4390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty