Provider Demographics
NPI:1780867523
Name:KSHONZ, TODD MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:KSHONZ
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 1:343 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2517
Mailing Address - Country:US
Mailing Address - Phone:516-823-3333
Mailing Address - Fax:
Practice Address - Street 1:343 MERRICK RD
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2517
Practice Address - Country:US
Practice Address - Phone:516-823-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-16
Last Update Date:2007-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04797811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice