Provider Demographics
NPI:1710048707
Name:STREZO, KEVIN M (DDS)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:STREZO
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 1:234 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOMER CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15748-1560
Mailing Address - Country:US
Mailing Address - Phone:724-479-8071
Mailing Address - Fax:724-479-4271
Practice Address - Street 1:234 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOMER CITY
Practice Address - State:PA
Practice Address - Zip Code:15748-1560
Practice Address - Country:US
Practice Address - Phone:724-479-8071
Practice Address - Fax:724-479-4271
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022773-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice