Provider Demographics
NPI:1710059159
Name:KENZIK, RAYMOND A (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:KENZIK
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 1:220 S NOVA RD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-6117
Mailing Address - Country:US
Mailing Address - Phone:386-672-9440
Mailing Address - Fax:386-672-4447
Practice Address - Street 1:220 S NOVA RD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6117
Practice Address - Country:US
Practice Address - Phone:386-672-9440
Practice Address - Fax:386-672-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN60251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics