Provider Demographics
NPI:1609974864
Name:KITZIS, GARY D
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:D
Last Name:KITZIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 PLAINVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2807
Mailing Address - Country:US
Mailing Address - Phone:516-692-7766
Mailing Address - Fax:631-692-6129
Practice Address - Street 1:156 PLAINVIEW RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2807
Practice Address - Country:US
Practice Address - Phone:516-692-7766
Practice Address - Fax:631-692-6129
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist